Cyclopia is a rare genetic defect. It is the most severe form of alobar holoprosencephaly, characterized by the fusion of the two orbits and is linked to the lack of development of the frontal bud falling within the f...Cyclopia is a rare genetic defect. It is the most severe form of alobar holoprosencephaly, characterized by the fusion of the two orbits and is linked to the lack of development of the frontal bud falling within the framework of ectroprosopia. </span><b><span style="font-family:Verdana;">Case presentation: </span></b><span style="font-family:Verdana;">This is a case report of Gravida 3 Para 3, 32 years old and without a history of abortion, with a history of normal vaginal birth which occurs during labor latency with active movements of the fetus present and cardiac activity on auscultation with pinard stethoscope. The uterine height was 32 cm with well palpated fetal poles. Ultrasound examination confirms the presence of normal cardiac activity with a poorly responsive fetus. After labor management, she gave birth 3 hours after admission to the maternity ward of a living newborn male weighing 2800 g with an Apgar score of 4/10 at the first minute and 2/10 at the fifth minute. He died 10 minutes later at the maternity hospital of the Saint-Louis regional hospital center, in northern Senegal. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Holoprosencephaly is certainly rare but remains the most common structural congenital anomaly of the brain with a complex and multifactorial pathogenesis. Early perinatal diagnosis and determination of severity are important to inform parents of the possibilities of a future life. The voluntary termination of pregnancy is an option but remains prohibited in the country to this day for these indications.展开更多
<strong>Objectives:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">To compare between hysterosalpingography (HSG) and laparoscop...<strong>Objectives:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">To compare between hysterosalpingography (HSG) and laparoscopic findings in patients tested for infertility and thereby to determine the significance of the latter examination. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">This was a descriptive study performed in two Gynecology departments in the Dakar (Senegal). Included were 84 patients with suspicious tubal-infertility who underwent HSG followed by laparoscopy. The Kappa (K) statistics was used to clarify the concordance between HSG vs. laparoscopy findings. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Kappa concordance between HSG and laparoscopy showed the followings: 0.08 for proximal tubal obstructions (poor agreement), 0.40 for distal tubal obstructions (moderate agreement), and -</span></span><span style="font-family:;" "=""><span><span style="font-family:Verdana;">0.08 for peritoneal adhesions (no agreement). Laparoscopy revealed pelvic adhesions in 84% of cases, pelvic endometriosis in 12% of cases, and apparently normal tubes in 12%. According to the distal tubal operability score, 16.6% of the lesions were classified as stage 4 and 23.8% at stage 1. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">HSG and laparoscopy findings did not agree in patients with tubal infertility, and thus, laparoscopy should be employed, especially when HSG showed abnormal findings. HSG has a low diagnostic value in adhesions.</span></span></span>展开更多
Background: “Low-risk” pregnancy is defined as a pregnancy that develops physiologically in a healthy woman and remains healthy. In practice, “low-risk” pregnancies are defined by excluding high-risk pregnancies. ...Background: “Low-risk” pregnancy is defined as a pregnancy that develops physiologically in a healthy woman and remains healthy. In practice, “low-risk” pregnancies are defined by excluding high-risk pregnancies. Objectives: Evaluate the rate of complications and medical interventions in “low-risk” pregnant women. Methods: This was a retrospective cohort study assessing the risk of obstetrical complications and medical interventions in low-risk patients from January 2010 to December 2020 at Philippe Maguilen Senghor Health Center in Dakar, Senegal. Results: There were 10,979 low-risk patients out of a total of 52,768, accounting for 20.8%. As medical interventions, episiotomy was performed in 27.5% and cesarean section in 8.7%. Acute fetal distress was observed in 4.1%. A low Apgar score at the fifth minute was observed in 1.89% (whereas it was 3.49% in high risk patients). Newborn-resuscitation was performed in 10.7%. Neonatal mortality was 5‰. Conclusion: Low-risk pregnancies are not without “risk”, and thus care-givers should prepare for risks even at dealing with low risk patients.展开更多
<strong>Background:</strong><span style="font-family:Verdana;"> Primary Immune Deficiencies (PID) are rare, under-determined </span><span style="font-family:"">&l...<strong>Background:</strong><span style="font-family:Verdana;"> Primary Immune Deficiencies (PID) are rare, under-determined </span><span style="font-family:""><span style="font-family:Verdana;">diseases particularly in sub-Saharan Africa. The diagnosis is often suspected with uncommon clinical signs. Infections are the main diagnostic circumstances in infants. Confirmation is often difficult because some additional examinations are unavailable in many of our countries. </span><b><span style="font-family:Verdana;">Aim: </span></b><span style="font-family:Verdana;">Our aim was to share the challenge of diagnosis and treatment in PID. </span><b><span style="font-family:Verdana;">Case Presentation:</span></b><span style="font-family:Verdana;"> It is about two infants, a boy and a girl, with early several infections. Both of them presented a hypo-gammaglobulinemia and to the boy, the immuno-phenotyping lymphocyte showed a decrease</span></span><span style="font-family:Verdana;">d</span><span style="font-family:Verdana;"> level of lymphocytes CD19. We are looking for genetic confirmation but it is not easy. The treatment of these infants require</span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> a substitution for life of immunoglobulin w</span><span style="font-family:Verdana;">h</span><span style="font-family:Verdana;">ich </span><span style="font-family:Verdana;">is</span><span style="font-family:""><span style="font-family:Verdana;"> unavailable in our countries. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> PID are suspected with atypical clinical signs. Confirmation genetic diagnosis is difficult in low income countries. To improve the follow up, we need to strengthen clinical-biological collaboration.</span></span>展开更多
“Locked twins” is a rare event occurring in about 1 in every 1000 twin births. A 21-year-old primigravida with a 31-week twin pregnancy was admitted for delivery. The head of the first twin was locked to the chin of...“Locked twins” is a rare event occurring in about 1 in every 1000 twin births. A 21-year-old primigravida with a 31-week twin pregnancy was admitted for delivery. The head of the first twin was locked to the chin of the second twin at the top of the symphysis pubis. Caesarean section was performed allowing the delivery of both dead twins. Twins gestations with first twin in the breech </span><span style="font-family:Verdana;">presentation raise index of suspicion of potential locked twin. However,</span><span style="font-family:Verdana;"> management of such situation is controversial with most authors and colleges re</span><span style="font-family:Verdana;">commending caesarean section to avoid interlocking heads. We report</span><span style="font-family:Verdana;"> another rare case of interlocking heads and bring up the topic about management of breech-first twin deliveries.展开更多
Objectives: This study aimed to assess efficacy of intramuscular methotrexate 8-day protocol in the treatment of low-risk gestational trophoblastic neoplasia and also identify prognostic factors associated with treatm...Objectives: This study aimed to assess efficacy of intramuscular methotrexate 8-day protocol in the treatment of low-risk gestational trophoblastic neoplasia and also identify prognostic factors associated with treatment failure, necessitating second line chemotherapy. Methods: This study was performed at Gynaecologic and Obstetric Clinic of Dakar Teaching Hospital, the reference Centre of Gestational Trophoblastic Disease in Senegal. At the beginning of 2011, patients were followed according to FIGO’s recommendations. From 2011 to 2014, we diagnosed 88 low-risk gestational trophoblastic neoplasia (GTN) patients (WHO score < 7). Low-risk patients started their treatment with methotrexate (MTX) based on the 8-day protocol consisting of 1 mg/kg MTX in combination with 0.1 mg/kg folinic acid (FA) every other day. Resistance to treatment was the main outcome. We studied the association of different prognostic factors included in the World Health Organisation (WHO) scoring system and resistance to the initial single agent chemotherapy. Results: Eighty-eight patients were diagnosed for GTN during the study period. Average age was 31 years. The antecedent pregnancy was molar in 98.1% of cases. Seventy-four patients underwent remission after single agent-chemotherapy. Resistance rate to single-agent chemotherapy was 15.9% (14 patients). Nine of them achieved remission after second line chemotherapy. WHO score was significantly associated with the risk of resistance to single-agent chemotherapy. Other variables included in the WHO as age, antecedent pregnancy, pre-treatment hCG, tumour size and FIGO stage were not significantly associated with resistance. We report five fatal cases. Conclusion: The 8-day protocol consisting of 1 mg/kg MTX in combination with 0.1 mg/kg folinic acid (FA) every other day is effective for women with LRGTN. The only significant prognostic factor for failure is pretreatment WHO score. We highly recommend the use of this protocol particularly in developing countries where methotrexate is avail展开更多
Objectives: To report our experience in using an electronic database for management of breast diseases in a developing country. Materials and methods: E-Breast is a database developed on FileMaker Pro Advanced to serv...Objectives: To report our experience in using an electronic database for management of breast diseases in a developing country. Materials and methods: E-Breast is a database developed on FileMaker Pro Advanced to serve as patient file and breast diseases registry. The development of the platform, its usage and advantages on a manual filing system are described. Results: For 6 years, we use this database, which accounts more than 2000 patients and includes data from more than 10 years. An overview of the activity is easily generated by E-Breast. The generated reports are used to the routine care of patients, statistics and clinical research. Data entered are immediately useful in addition to simultaneously implement the database for clinical research. Many custom features are integrated. For research purposes, the system has the ability to perform detailed analyses on subsets defined by the user as breast cancer, breast benign diseases, etc. Conclusion: E-Breast has proven to be a useful way of documentation that has become an integral and essential part of the daily activity and also a valuable research tool.展开更多
文摘Cyclopia is a rare genetic defect. It is the most severe form of alobar holoprosencephaly, characterized by the fusion of the two orbits and is linked to the lack of development of the frontal bud falling within the framework of ectroprosopia. </span><b><span style="font-family:Verdana;">Case presentation: </span></b><span style="font-family:Verdana;">This is a case report of Gravida 3 Para 3, 32 years old and without a history of abortion, with a history of normal vaginal birth which occurs during labor latency with active movements of the fetus present and cardiac activity on auscultation with pinard stethoscope. The uterine height was 32 cm with well palpated fetal poles. Ultrasound examination confirms the presence of normal cardiac activity with a poorly responsive fetus. After labor management, she gave birth 3 hours after admission to the maternity ward of a living newborn male weighing 2800 g with an Apgar score of 4/10 at the first minute and 2/10 at the fifth minute. He died 10 minutes later at the maternity hospital of the Saint-Louis regional hospital center, in northern Senegal. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Holoprosencephaly is certainly rare but remains the most common structural congenital anomaly of the brain with a complex and multifactorial pathogenesis. Early perinatal diagnosis and determination of severity are important to inform parents of the possibilities of a future life. The voluntary termination of pregnancy is an option but remains prohibited in the country to this day for these indications.
文摘<strong>Objectives:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">To compare between hysterosalpingography (HSG) and laparoscopic findings in patients tested for infertility and thereby to determine the significance of the latter examination. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">This was a descriptive study performed in two Gynecology departments in the Dakar (Senegal). Included were 84 patients with suspicious tubal-infertility who underwent HSG followed by laparoscopy. The Kappa (K) statistics was used to clarify the concordance between HSG vs. laparoscopy findings. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Kappa concordance between HSG and laparoscopy showed the followings: 0.08 for proximal tubal obstructions (poor agreement), 0.40 for distal tubal obstructions (moderate agreement), and -</span></span><span style="font-family:;" "=""><span><span style="font-family:Verdana;">0.08 for peritoneal adhesions (no agreement). Laparoscopy revealed pelvic adhesions in 84% of cases, pelvic endometriosis in 12% of cases, and apparently normal tubes in 12%. According to the distal tubal operability score, 16.6% of the lesions were classified as stage 4 and 23.8% at stage 1. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">HSG and laparoscopy findings did not agree in patients with tubal infertility, and thus, laparoscopy should be employed, especially when HSG showed abnormal findings. HSG has a low diagnostic value in adhesions.</span></span></span>
文摘Background: “Low-risk” pregnancy is defined as a pregnancy that develops physiologically in a healthy woman and remains healthy. In practice, “low-risk” pregnancies are defined by excluding high-risk pregnancies. Objectives: Evaluate the rate of complications and medical interventions in “low-risk” pregnant women. Methods: This was a retrospective cohort study assessing the risk of obstetrical complications and medical interventions in low-risk patients from January 2010 to December 2020 at Philippe Maguilen Senghor Health Center in Dakar, Senegal. Results: There were 10,979 low-risk patients out of a total of 52,768, accounting for 20.8%. As medical interventions, episiotomy was performed in 27.5% and cesarean section in 8.7%. Acute fetal distress was observed in 4.1%. A low Apgar score at the fifth minute was observed in 1.89% (whereas it was 3.49% in high risk patients). Newborn-resuscitation was performed in 10.7%. Neonatal mortality was 5‰. Conclusion: Low-risk pregnancies are not without “risk”, and thus care-givers should prepare for risks even at dealing with low risk patients.
文摘<strong>Background:</strong><span style="font-family:Verdana;"> Primary Immune Deficiencies (PID) are rare, under-determined </span><span style="font-family:""><span style="font-family:Verdana;">diseases particularly in sub-Saharan Africa. The diagnosis is often suspected with uncommon clinical signs. Infections are the main diagnostic circumstances in infants. Confirmation is often difficult because some additional examinations are unavailable in many of our countries. </span><b><span style="font-family:Verdana;">Aim: </span></b><span style="font-family:Verdana;">Our aim was to share the challenge of diagnosis and treatment in PID. </span><b><span style="font-family:Verdana;">Case Presentation:</span></b><span style="font-family:Verdana;"> It is about two infants, a boy and a girl, with early several infections. Both of them presented a hypo-gammaglobulinemia and to the boy, the immuno-phenotyping lymphocyte showed a decrease</span></span><span style="font-family:Verdana;">d</span><span style="font-family:Verdana;"> level of lymphocytes CD19. We are looking for genetic confirmation but it is not easy. The treatment of these infants require</span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> a substitution for life of immunoglobulin w</span><span style="font-family:Verdana;">h</span><span style="font-family:Verdana;">ich </span><span style="font-family:Verdana;">is</span><span style="font-family:""><span style="font-family:Verdana;"> unavailable in our countries. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> PID are suspected with atypical clinical signs. Confirmation genetic diagnosis is difficult in low income countries. To improve the follow up, we need to strengthen clinical-biological collaboration.</span></span>
文摘“Locked twins” is a rare event occurring in about 1 in every 1000 twin births. A 21-year-old primigravida with a 31-week twin pregnancy was admitted for delivery. The head of the first twin was locked to the chin of the second twin at the top of the symphysis pubis. Caesarean section was performed allowing the delivery of both dead twins. Twins gestations with first twin in the breech </span><span style="font-family:Verdana;">presentation raise index of suspicion of potential locked twin. However,</span><span style="font-family:Verdana;"> management of such situation is controversial with most authors and colleges re</span><span style="font-family:Verdana;">commending caesarean section to avoid interlocking heads. We report</span><span style="font-family:Verdana;"> another rare case of interlocking heads and bring up the topic about management of breech-first twin deliveries.
文摘Objectives: This study aimed to assess efficacy of intramuscular methotrexate 8-day protocol in the treatment of low-risk gestational trophoblastic neoplasia and also identify prognostic factors associated with treatment failure, necessitating second line chemotherapy. Methods: This study was performed at Gynaecologic and Obstetric Clinic of Dakar Teaching Hospital, the reference Centre of Gestational Trophoblastic Disease in Senegal. At the beginning of 2011, patients were followed according to FIGO’s recommendations. From 2011 to 2014, we diagnosed 88 low-risk gestational trophoblastic neoplasia (GTN) patients (WHO score < 7). Low-risk patients started their treatment with methotrexate (MTX) based on the 8-day protocol consisting of 1 mg/kg MTX in combination with 0.1 mg/kg folinic acid (FA) every other day. Resistance to treatment was the main outcome. We studied the association of different prognostic factors included in the World Health Organisation (WHO) scoring system and resistance to the initial single agent chemotherapy. Results: Eighty-eight patients were diagnosed for GTN during the study period. Average age was 31 years. The antecedent pregnancy was molar in 98.1% of cases. Seventy-four patients underwent remission after single agent-chemotherapy. Resistance rate to single-agent chemotherapy was 15.9% (14 patients). Nine of them achieved remission after second line chemotherapy. WHO score was significantly associated with the risk of resistance to single-agent chemotherapy. Other variables included in the WHO as age, antecedent pregnancy, pre-treatment hCG, tumour size and FIGO stage were not significantly associated with resistance. We report five fatal cases. Conclusion: The 8-day protocol consisting of 1 mg/kg MTX in combination with 0.1 mg/kg folinic acid (FA) every other day is effective for women with LRGTN. The only significant prognostic factor for failure is pretreatment WHO score. We highly recommend the use of this protocol particularly in developing countries where methotrexate is avail
文摘Objectives: To report our experience in using an electronic database for management of breast diseases in a developing country. Materials and methods: E-Breast is a database developed on FileMaker Pro Advanced to serve as patient file and breast diseases registry. The development of the platform, its usage and advantages on a manual filing system are described. Results: For 6 years, we use this database, which accounts more than 2000 patients and includes data from more than 10 years. An overview of the activity is easily generated by E-Breast. The generated reports are used to the routine care of patients, statistics and clinical research. Data entered are immediately useful in addition to simultaneously implement the database for clinical research. Many custom features are integrated. For research purposes, the system has the ability to perform detailed analyses on subsets defined by the user as breast cancer, breast benign diseases, etc. Conclusion: E-Breast has proven to be a useful way of documentation that has become an integral and essential part of the daily activity and also a valuable research tool.
