The granular cell tumor of the breast is a rare tumor and a usually benign disease that appears clinically and radiologically like a malign tumor. We report a case of GCT in a woman of 41 years, who present a clinical...The granular cell tumor of the breast is a rare tumor and a usually benign disease that appears clinically and radiologically like a malign tumor. We report a case of GCT in a woman of 41 years, who present a clinically and radiologically suspect later. The anatomopathological examination showed the benign tumor proliferation and a large tumorectomy was realized. The immunostaining with PS100 and NSE protein confirm the nature of the tumor.展开更多
Objectives: This paper aims to study the epidemiology and causes of fetal deaths in utero at Regional Hospital Amath Dansokho of Kedougou (RHADK). Methodology: This was a retrospective epidemiological study conducted ...Objectives: This paper aims to study the epidemiology and causes of fetal deaths in utero at Regional Hospital Amath Dansokho of Kedougou (RHADK). Methodology: This was a retrospective epidemiological study conducted at the Maternity Ward of the Regional Hospital Amath Dansokho of Kedougou from June 01, 2022 to June 30, 2023, including all patients seen for delivery care. Data were analyzed using Statistical Package for Social Science (SPSS 22, Windows version). The parameters studied were the frequency of in-utero fetal death, sociodemographic characteristics, pregnancy and delivery data, neonatal data and cause-of-death classification according to the Cause of Death and Associated Conditions (CODAC) classification. Results: We recorded 1628 deliveries, with 231 cases of in-utero fetal death, a frequency of 14.2%. Fetal death occurred most frequently in multiparous women (64.5%). The majority of patients (72.3%) were transferred. 51.9% of patients with fetal death had at least 3 antenatal visits. On admission, fetal heart rate was absent in 73.2% of patients. The etiology of in-utero fetal death was dominated by maternal factors (high blood pressure, anaemia and diabetes), which accounted for 36.9% of deaths, followed by placental pathologies (retroplacental haematoma) and intrapartum pathologies (uterine rupture, abnormal presentation). Conclusion: In-utero fetal death can be prevented, and is mainly due to direct obstetric complications. The focus should be on the prevention and management of hypertensive disorders and their complications during pregnancy, the fight against anaemia and, above all, the rapid and correct management of dystocia.展开更多
Health facilities are generally short-staffed and overworked. This has a significant impact on the reliability of the acquisition of health constants required at the start of diagnosis. Manual acquisition and transmis...Health facilities are generally short-staffed and overworked. This has a significant impact on the reliability of the acquisition of health constants required at the start of diagnosis. Manual acquisition and transmission of these constants and other data leads to delays in the execution of successive care-related tasks. What’s more, the quality of service is sometimes compromised by a lack of communication between patients and staff. In pediatrics, this is compounded by the difficulty of diagnosis in the face of children’s silence, intimidated by the hospital environment. Technological assistance would relieve healthcare staff of the need to perform certain repetitive tasks. The solution proposed in this document studies a robot, based on electrical, electronic, computer and artificial intelligence resources, with human-machine interaction for taking vitals and health data in health facilities. This system enables height, mass and temperature to be taken autonomously and without contact. The algorithm we’ve developed uses artificial intelligence to check the conditions for correct measurements, both bareheaded and barefoot. This solution also alerts you to epidemic trends such as obesity. This health data is made available in the healthcare facility on terminals such as tablets, smartphones and computers used by nursing staff. This work will help healthcare staff to take automatic health vitals without contact, and to acquire and circulate data via a computer network.展开更多
<strong>Objective</strong><strong>:</strong> <span><span><span style="font-family:""><span style="font-family:Verdana;">Maternal mortality remai...<strong>Objective</strong><strong>:</strong> <span><span><span style="font-family:""><span style="font-family:Verdana;">Maternal mortality remains a major concern in developing countries. This survey aims to suggest strategic plans that would help decrease maternal and perinatal mortality in the suburbs. It is a descriptive study that shows the different causes of maternal deaths during pregnancy and puerperium period. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">It is a retrospective descriptive study done between January 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> 2016 and the 31</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> of December 2018. We have collected information on all deaths due to mortality issues in Five (5) maternity clinics around Dakar. The record shows that teach centre have an average of 4000 deliveries per year. The data collected from the hospital records were inputted using Sphinx software (version 5). These data were analysed using Epi Info software (version 3.5). After analysing these data, recommendations were made to minimize the different causes of maternal deaths. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">We recorded 154 maternal deaths out of 32,420 live births. The direct causes of maternal deaths were a result of preeclampsia and its complications (31.2%), postpartum haemorrhage (24.7%), abruption placentae (20.8%) and obstructed labour (7.8%). The indirect causes were mainly sickle cell disease (1.3%), heart disease (1.3%) and gynaecological cancers (1.3%). Maternal deaths were also associated with fetal loss in 47.4% of 153 maternal deaths, need for blood transfusion 59% while none of the reference structures in the suburbs of Dakar has a blood bank;with a need for admission in intensive care unit was noted as 40%. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Thus, preeclampsia and its complications are the leading cause of maternal deaths in suburban settings. Timely availability of resuscitation units and liable blood products could drastically reduce maternal deaths from direct obstetric complications.</span></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
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
“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
<strong>Introduction: </strong><span><span><span style="font-family:""><span style="font-family:Verdana;">In Senegal, according to the 2017 Demographic Heal...<strong>Introduction: </strong><span><span><span style="font-family:""><span style="font-family:Verdana;">In Senegal, according to the 2017 Demographic Health Survey, </span><span style="font-family:Verdana;">about 22% of married women have an unmet need for family planning. Globally</span><span style="font-family:Verdana;">, 61% of women do not have access to postpartum family planning. </span><b><span style="font-family:Verdana;">Material </span><span style="font-family:Verdana;">and Method: </span></b><span style="font-family:Verdana;">This is a prospective, descriptive and analytical study from March</span><span style="font-family:Verdana;"> 05, 2017 to January 31, 2018. The interrogation was done in the hospital ward with filling in the data collection form. The data collected was first coded and then entered, using the sphinx software. The data analysis was done with Epi info version 7 software and included a descriptive and analytical component. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">The average age of the patients was 26 years with extremes of 15 and </span><span style="font-family:Verdana;">48 years. Average gestation was 2.3 with extremes of 1 and 8 pregnancies. More </span><span style="font-family:Verdana;">than half of the women (64.7%) had delivered by caesarean in an emergency setting. More than half of the women (66.7%) had chosen the hormonal contraceptive method within 48 hours of delivery and the implant was the type of </span><span><span style="font-family:Verdana;">contraceptive prescribed in almost half of the cases (49.3%). </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Integrating postpartum family planning into programs will ultimately help to dramat</span></span><span style="font-family:Verdana;">ically decrease high-risk pregnancies, decrease the </span><span style="font-family:Verdana;">unmet need for family plannin</span><span style="font-family:Verdana;">g (FP), and improve the health and survival of mothers and children.</span></span></span></span>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 available, affordable and relatively safe.展开更多
<strong>Introduction:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Cystic breast cancer is a rare entity. Breast cyst...<strong>Introduction:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Cystic breast cancer is a rare entity. Breast cysts are most often benign. The clinical characteristics of malignancy are not specific. </span><b><span style="font-family:Verdana;">Objective:</span></b> <span style="font-family:Verdana;">To report a series of malignant cystic tumors of the breast and to describe</span><span style="font-family:Verdana;"> their different characteristics. </span><b><span style="font-family:Verdana;">Materials and Methods:</span></b><span style="font-family:Verdana;"> This was an observational study carried out between January 2018 and October 2021 at the Dakar </span><span style="font-family:Verdana;">university surgical oncology unit. We studied the clinical appearance, im</span><span style="font-family:Verdana;">ag</span><span style="font-family:Verdana;">ing, </span><span style="font-family:Verdana;">histopathology, extent of disease and treatment. We did not include cases of</span><span style="font-family:Verdana;"> pure, single, or multiple chronically progressive cysts. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> There were 8 </span><span style="font-family:Verdana;">patients, 6 women and 2 men. The average age was 44. All patients presented </span><span style="font-family:Verdana;">with a palpable unilateral deforming skin mass without inflammatory </span><span style="font-family:Verdana;">character. One patient presented with a bloody discharge. The cyst was</span><span style="font-family:Verdana;"> multilocular with</span><span style="font-family:Verdana;">out intracystic growth in 2 cases and presented a growth signal in 6 cases.</span> <span style="font-family:Verdana;">Imaging was ACR 3 in 5 cases and ACR 4 in 3 cases. Histopathology found 6</span><span style="font-family:Verdana;"> in</span><span style="font-family:Verdana;">va</span><span style="font-family:Verdana;">sive carcinomas including 2 papillary, 3 Invasive Carcinoma of No Special</span><span style="font-family:Verdana;"> Type (ICNST), 1 lobular carcinoma as well as one case of lobular carcinoma </span><i><span style="font-family:Verdana;">in situ</span></i><span style="font-family:Verdana;"> of the comedocarcinoma type in women and 2 ICNST in men. The extension </span><span style="font-family:Verdana;">workup was found in only 1 male patient in the presence of metastases.</span><span style="font-family:Verdana;"> Treatment included chemotherapy, mastectomy and radiotherapy for 6 of </span><span style="font-family:Verdana;">the patients. There wasn’t any complete response for invasive cases. Survival is 100% to date.</span><span> <b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Cystic breast tumors sometimes hide the cancer</span></span><span style="font-family:Verdana;"> that is difficult to diagnose. The prognosis seems favorable, however.</span></span></span></span>展开更多
Objectives: The aim of our study was to investigate the relation of some sociodemographic factors and delays presentation in breast cancer. Patients and method: This was an observational study in Breast Unit of Aristi...Objectives: The aim of our study was to investigate the relation of some sociodemographic factors and delays presentation in breast cancer. Patients and method: This was an observational study in Breast Unit of Aristide Le Dantec Teaching Hospital in Dakar. Were included in the study all patients followed for breast cancer from January 2008 to December 2014. The following variables were selected and stratified: age, place of living, educational attainment, menopausal status, socioeconomic status and family history of breast cancer. For each variable, an association with the stage and presentation delay was assessed. Results: Two hundred and fifty nine (259) patients met the inclusion criteria. No correlation was found between the studied socio-demographic factors and delay. Negative history of family breast cancer was associated with presentation delay. The only factor associated with locally advanced breast cancer after adjusting confounding factors was low level of income. Conclusion: A significant percentage of women with breast cancer in Senegal are experiencing presentation delay. Coordinated efforts with public health department are needed to educate the focused groups and mitigate the barriers.展开更多
OBJECTIVES: 1) To draw up the epidemiological profile of patients who have benefited from cervical cancer screening by visual inspection after application of acetic acid (VIA) and then describe the results of the test...OBJECTIVES: 1) To draw up the epidemiological profile of patients who have benefited from cervical cancer screening by visual inspection after application of acetic acid (VIA) and then describe the results of the test, the colposcopy, histological and therapeutic aspects in case of dysplasia. 2) To evaluate the performance of IVA in cervical cancer screening and its feasibility in low-resource countries. MATERIALS AND METHODS: This was a prospective and descriptive study carried out from 06 June 2015 to 31 January 2016 (7 months) at the Maternity Center at Nabil Choucair health center in Dakar. The patients had been screened for cervical cancer by visual inspection, which consisted of applying 3% acetic acid after setting up a vaginal speculum. The test was considered positive if there were intense white areas in the cervix. Colposcopy was performed in case of a positive VIA result. This colposcopy included an unprepared examination, an examination after application of 3% acetic acid and an examination after application of Lugol solution. The colposcopic report is made according to the terminology of the French Society of Colposcopy and Cervico-Vaginal Pathology. Patients with major changes or unsatisfactory colposcopy had undergone diathermic loop resection. Surgical specimens were sent to pathologic anatomy and follow-up was performed according to the results of the histology. The studied parameters concerned the socio-demographic aspects, the results of the VIA test, the results of the colposcopy after a positive test, the therapeutic aspects in case atypical transformation zone grade 2 or of unsatisfactory colposcopy, the results of the histology after the conization and the followed. The collection of data was done thanks to a file and the statistical analysis thanks to the software Epi-info version 7. RESULTS: 899 patients were involved in the study. The epidemiologic profile of our patient was a multipara in a period of genital activity, aged 42.2 years with a mean gestational weight of 4.5, and a parity of 4. In our series, the patients had their first sexual intercourse with 20.8 years old. In our study, 84 patients (10.2%) had positive results after visual inspection after acetic acid applications. All patients with positive results after application of 3% acetic acid had colposcopy. In our study, 27 patients had major changes and/or unsatisfactory colposcopy and underwent diathermic loop resection for diagnostic and therapeutic purposes. Anatomo-pathological examination of the cone room revealed cervicitis in 22.2% of cases, flat condyloma in 7.4% of cases, CIN2 in 22.2% of cases, and CIN3 in 18.5% of cases. All the conizations were in sano. The postoperative course was simple. CONCLUSION: Cervical cancer is a real public health problem in developing countries. To do to human resources, developing countries like Senegal must put in place simple, inexpensive, effective strategies that must globally respond to “screen and treat”.展开更多
Objectives: To evaluate a medical data management system of a mammogram unit in a department of Radiology. Methods: This is a qualitative and quantitative assessment study in Fann Teaching Hospital between April 2014 ...Objectives: To evaluate a medical data management system of a mammogram unit in a department of Radiology. Methods: This is a qualitative and quantitative assessment study in Fann Teaching Hospital between April 2014 and June 2015 one year after its implementation. The quantitative component consisted of the audit of the database to determine the socio-demographic characteristics of patients and the results of mammograms. The qualitative component assessed users’ experience. For analysis, quantitative data were extracted and transferred to Microsoft Excel. For scale variables, we calculated the averages and extremes. For qualitative variables, we established percentages. Results: During the study period, 433 patients underwent mammograms. The average age of patients was 48 years. The completion rate maintained above 85% was below 26% in the first two months of use. As to the completeness given examinations, it was still above 83%. The results of mammogram examinations were normal in the majority of cases: 96% for the right breast and 95.2% for the left breast. All users had a favourable opinion about the database. The reasons were better work organization, comprehensiveness, accessibility and standardization of information about the patient and especially the immediate availability of statistics. For 60% of these health professionals, complaints related to the use of the software were the time-consuming of filling data. Conclusion: This study mainly describes the perception of health professionals on the computerization of radiological examinations. It offers some advantages, proposes improvements and opens avenues for reflection on the globalization of the computerization of patient records in Radiology.展开更多
Objectives: The aim of this study was to analyse key factors and main indications of primary caesarean sections and find out ways to reduce the rising rates. Patients and method: This was a longitudinal and retrospect...Objectives: The aim of this study was to analyse key factors and main indications of primary caesarean sections and find out ways to reduce the rising rates. Patients and method: This was a longitudinal and retrospective study carried out from 1 January 2012 to 31 December 2016. The study included all patients in whom a primary CS was performed. A previous uterine scar was a non-inclusion criterion. We analysed the main indications and their trends during these five years, Apgar score at the 5th minute according to the course of caesarean section rate and the impact of daily audit. Data were collected retrospectively from 2012 to 2015, then prospectively in 2016 using a Filemaker database. Data were analysed with SPSS 21 software, Mac version. Averages were calculated for quantitative data and percentage for qualitative ones. The statistical tests used were the Pearson Chi2 test. The differences observed were considered significant when the p value was less than 0.05. Results: During the study period, we registered 21.308 deliveries and 6.292 caesarean sections (29.5%). Primary CS concerned 72.5% of overall CS. The main indications were suspicious of fetal distress (29.1%), obstructed or prolonged labour (21.7%), breech and twin delivery with respectively 8.2% and 5.2%. We registered more vaginal deliveries with induction of labour: 81.4% versus 75.2%. An obstetrical audit allowed better management of labour and decrease of CS rate. Conclusion: We need to focus on diagnosis of fetal distress, management of breech presentation in twin delivery and singleton. The induction of labour can be an effective alternative in some indications. An obstetrical audit is necessary to reverse caesarean section rate.展开更多
Objectives:?Investigating the relation between perinatal outcomes and?hospital working shifts.?Methods:?We conducted a cross-sectional study at Philippe Maguilen Senghor health center (PMSHC) in Dakar, Senegal from Ja...Objectives:?Investigating the relation between perinatal outcomes and?hospital working shifts.?Methods:?We conducted a cross-sectional study at Philippe Maguilen Senghor health center (PMSHC) in Dakar, Senegal from January, 1st?2011 to December, 31th 2018. The study population was comprised of all mothers who had delivered at PMSHC and their newborns after completing 22 weeks of gestation. Time of delivery was?divided into three periods of working hours: morning shift (deliveries occurred between 7 am and 4:59 pm);evening shift from 5 pm to 10:59 pm and night shift from 11?pm to 6:59 am.?Maternal outcomes were assessed by mode of delivery, epsisotomy and perineal injuries.?The Apgar scoring system was used to assess newborns at first minute after they were born. Other adverse perinatal outcomes included fresh stillbirth, neonatal referral and early neonatal death. Data were analyzed using Statistical Package for Social Science software (SPSS 24, Mac version).?Results:?A total of 48,270 mothers and their newborns met eligibility criteria. Caesarean section deliveries were less likely to occur during evening (OR 0.84, 95% CI;0.79?-?0.89, p = 0.001) and night shifts (OR 0.45, CI;0.47?-?0.53, p = 0.001).?Evening shift deliveries had 1.1 the odds of poor perinatal outcome (Apgar score ?- 1.18, p = 0.012). No significant difference was found in the odds of neonate referrals and deaths across the three shifts.?Night shift deliveries had 1.1 the odds of perineal injuries compared to morning shift deliveries (OR 1.11, 95% CI;1.04?- 1.18, p = 0.001, for episiotomy and OR, 1.14;95% CI, 1.04?- 1.26, p = 0.008, for perineal tears). Conclusion:?Off-hours deliveries, particularly during the night shift, were significantly associated with higher proportions of perineal injuries compared to morning shift.?However, no significant difference was found in the odds of neonate referrals and deaths across the three shifts.?Our findings suggest to set up a Neonatology unit at the CSPMS as well as a perinatal network across the country.展开更多
Objective: To assess a training approach in Emergency Obstetric and Neonatal Care (EmONC) to strengthen skills of healthcare providers and reduce maternal mortality. Materials and methods: The approach was based on th...Objective: To assess a training approach in Emergency Obstetric and Neonatal Care (EmONC) to strengthen skills of healthcare providers and reduce maternal mortality. Materials and methods: The approach was based on the skills training using the so-called “humanist” method and “life saving skills”. Simulated practice took place in the classroom through thirteen clinical stations summarizing the clinical skills on EmONC. The evaluation was done in all phases and the results were recorded in a database to document the progress of each learner. Results: We trained 432 providers in 10 months. The increase in technical achievements of each participant was documented through a database. The combination of training based on the model “learning by doing” has ensured learning and mastering all EmONC skills particularly postpartum haemorrhage management and reduced missed learning opportunities. Conclusion: The impact of training on postpartum haemorrhage management and maternal mortality is a major challenge in terms of prospects.展开更多
Objective: Describe the design and implementation of an electronic medical record—E-INTMED—customized for Internal Medicine in Dakar, Senegal. Methodology: This study was carried out in a public teaching hospital in...Objective: Describe the design and implementation of an electronic medical record—E-INTMED—customized for Internal Medicine in Dakar, Senegal. Methodology: This study was carried out in a public teaching hospital in Dakar Senegal. It entailed collaboration between physicians specialized in various fields in Internal Medicine and Computer Scientists to carry out the compilation of data and their electronic transcription to produce a prototype which met users’ needs. Results: E-INTMED software is structured around several hierarchical tables allowing users to register and store all relevant patients’ information. E-INTMED structures patient’s data to provide a clear overview of their medical history and users’ activity performance. E-INTMED makes medical users’ life so much easier. Users can generate and send letters and prescriptions quickly and efficiently using the customized templates which they can modify or create new ones. In addition to these capabilities, all of the features expected in an Internal Medicine EHR are handled by E-INTMED, such as lab orders and results, mechanisms for continuity of care, embedding and access to images and documents, and so much more. E-INTMED provides medical students with a number of educational, practical and administrative advantages. Conclusion: Computerization of medical records has become a necessity today. Crossing the line to Electronic medical records could help to improve medical practice and medical training.展开更多
Objectives: To evaluate the prognosis of obstetric complications by parity in a suburban center in Dakar. Patients and Method: We conducted a retrospective and prospective, cross-sectional study that evaluated all wom...Objectives: To evaluate the prognosis of obstetric complications by parity in a suburban center in Dakar. Patients and Method: We conducted a retrospective and prospective, cross-sectional study that evaluated all women admitted to the Philippe Maguilen Senghor Health Center for the management of their pregnancy (childbirth, abortion, ectopic pregnancy), whether they were primiparous or multiparous. The data for this study covered a 66-month period, from January 1, 2012 to June 30, 2017. Data were entered into our E-perinatal computer database. They were then extracted and analyzed first on Microsoft Excel 2016 and then on SPSS 24, Windows version. Results: Between January 2012 and June 2017, we’ve registered 27,441 patients including 25,905 deliveries, 1415 abortions and 121 ectopic pregnancies. Direct obstetric complications involved 14.1% of our patients. 12.1% multiparous and 17.3% primiparous had at least one direct obstetric complication of World Health Organization (WHO). Antepartum haemorrhage, uterine rupture, ectopic pregnancy, and abortion complications were more common in multipara, whereas prolonged and obstructed labor, preeclampsia, and eclampsia were more common in primiparous women. Postpartum haemorrhage occurred at substantially equal frequencies in both parity groups. We had not found any case of sepsis. Conclusion: Our study confirms that primiparity is a factor that may lead to obstetric complications. However, while some complications were more common in the primiparous, others were exclusive to multiparous when we did not expect it. We also recommend continuing this work by singling out multiparas and large multiparas, in order to better understand the obstetric prognosis linked to parity.展开更多
Objectives: To assess the quality of the obstetric evacuation system at the Youssou Mbargane Diop Hospital in Dakar. Methods: Our study was conducted at the Hospital of Youssou Mbargane DIOP in Rufisque, a district ab...Objectives: To assess the quality of the obstetric evacuation system at the Youssou Mbargane Diop Hospital in Dakar. Methods: Our study was conducted at the Hospital of Youssou Mbargane DIOP in Rufisque, a district about 26 km from downtown Dakar. This was a qualitative and evaluative descriptive study in the form of operational research aimed at improving the quality of obstetrical evacuations and resolving problems through a dynamic and team approach. It was carried out within the framework of the AQUASOU project (Improvement of Quality and Access to Emergency Obstetric Care in French). A liaison sheet was completed at the arrival of each evacuated patient, prospectively during the period from December 24 2006 to July 10 2008. The epidemiological characteristics were, origin of the evacuated, the evacuation conditions, evacuation patterns and therapeutic data. The data were collected through an Excel database developed for this purpose. The analysis was done using the Epi-Info version 6.0 software. Results: The frequency of evacuations was 23.2%. The average age of our patients was 25.3 years with extremes of 14 years and 48 years. More than half of the evacuees (59%) came from the Sanitary District of Rufisque. The majority of evacuations were made in a taxi (76.5%). An ambulance was used in 190 cases (20.6%). Seated transport was performed in 78% of cases. The transfer was medicalized in almost one-third of cases (29.3%). A liaison sheet was established during the transfer of patients in 77% of the cases. Evacuations were related to hemorrhage in 23.3%, dystocia in 22.2%, and fetal-adnexal anomaly in 17.3% of cases. No treatment was instituted before evacuation in 56% of evacuees. 48.5% of the evacuees had received treatment beyond. Conclusion: The poor quality of obstetric evacuations seems to be a brake on the decline in maternal and neonatal mortality in Senegal. Training and retraining of health personnel would improve maternal-fetal and neonatal morbidity and mortality.展开更多
The counter-referral system is particularly important for care during pregnancy, childbirth and the post-partum period as it facilitates access to emergency obstetric and neonatal care. It allows people to access care...The counter-referral system is particularly important for care during pregnancy, childbirth and the post-partum period as it facilitates access to emergency obstetric and neonatal care. It allows people to access care that is not likely to be provided at the base and to manage certain complications arising in emergency settings. We therefore looked at the evaluation of obstetric evacuations from the Touba Ndamatou public health. Methodology: This was a retrospective study of descriptive and analytical type extending over a period of 12 months from January 1, 2020 to December 31, 2020 at the public hospital health establishment (PHHE) of Touba Ndamatou. Results: One thousand five hundred and sixty (1560) patients evacuated for obstetrical reasons were collected out of a total admission of 5560, i.e., a frequency of 28%. The average age of the patients was 25.54 years. The mean gestation was 3.24 pregnancies. The average parity was 3.04 deliveries. Almost all of our patients (99%) were married. Slightly more than one in two women (53.6%) had performed at least 2 or 3 Prenatal consultations. 80% of parturients had traveled a distance of less than 20 km. 623 patients came by their own means (54.6%). Evacuation was provided by an ambulance in 509 patients, i.e., 44.6%. Arterial hypertension and its complications were the frequent reason for evacuations with approximately one in four patients (26.2%). Only 3.6% of patients had qualified personnel on board being evacuated. In our series, 13 deaths were recorded, i.e., 1.1% of cases. The distance traveled seemed not to influence the future of the mother (p = 0.51). The non-accompaniment of the patient during the evacuation by a medical staff seemed to influence the prognosis of the mother (p = 0.031). Fetal morbidity was higher among evacuees not accompanied by medical personnel. The state of apparent death was observed in the majority of cases in patients received over a distance of more than 20 km. Conclusion: Evacuation requires a clear definition of the roles and responsibilities of each level of the health pyramid, good organization in the health structures as well as within the community, and a good information system.展开更多
文摘The granular cell tumor of the breast is a rare tumor and a usually benign disease that appears clinically and radiologically like a malign tumor. We report a case of GCT in a woman of 41 years, who present a clinically and radiologically suspect later. The anatomopathological examination showed the benign tumor proliferation and a large tumorectomy was realized. The immunostaining with PS100 and NSE protein confirm the nature of the tumor.
文摘Objectives: This paper aims to study the epidemiology and causes of fetal deaths in utero at Regional Hospital Amath Dansokho of Kedougou (RHADK). Methodology: This was a retrospective epidemiological study conducted at the Maternity Ward of the Regional Hospital Amath Dansokho of Kedougou from June 01, 2022 to June 30, 2023, including all patients seen for delivery care. Data were analyzed using Statistical Package for Social Science (SPSS 22, Windows version). The parameters studied were the frequency of in-utero fetal death, sociodemographic characteristics, pregnancy and delivery data, neonatal data and cause-of-death classification according to the Cause of Death and Associated Conditions (CODAC) classification. Results: We recorded 1628 deliveries, with 231 cases of in-utero fetal death, a frequency of 14.2%. Fetal death occurred most frequently in multiparous women (64.5%). The majority of patients (72.3%) were transferred. 51.9% of patients with fetal death had at least 3 antenatal visits. On admission, fetal heart rate was absent in 73.2% of patients. The etiology of in-utero fetal death was dominated by maternal factors (high blood pressure, anaemia and diabetes), which accounted for 36.9% of deaths, followed by placental pathologies (retroplacental haematoma) and intrapartum pathologies (uterine rupture, abnormal presentation). Conclusion: In-utero fetal death can be prevented, and is mainly due to direct obstetric complications. The focus should be on the prevention and management of hypertensive disorders and their complications during pregnancy, the fight against anaemia and, above all, the rapid and correct management of dystocia.
文摘Health facilities are generally short-staffed and overworked. This has a significant impact on the reliability of the acquisition of health constants required at the start of diagnosis. Manual acquisition and transmission of these constants and other data leads to delays in the execution of successive care-related tasks. What’s more, the quality of service is sometimes compromised by a lack of communication between patients and staff. In pediatrics, this is compounded by the difficulty of diagnosis in the face of children’s silence, intimidated by the hospital environment. Technological assistance would relieve healthcare staff of the need to perform certain repetitive tasks. The solution proposed in this document studies a robot, based on electrical, electronic, computer and artificial intelligence resources, with human-machine interaction for taking vitals and health data in health facilities. This system enables height, mass and temperature to be taken autonomously and without contact. The algorithm we’ve developed uses artificial intelligence to check the conditions for correct measurements, both bareheaded and barefoot. This solution also alerts you to epidemic trends such as obesity. This health data is made available in the healthcare facility on terminals such as tablets, smartphones and computers used by nursing staff. This work will help healthcare staff to take automatic health vitals without contact, and to acquire and circulate data via a computer network.
文摘<strong>Objective</strong><strong>:</strong> <span><span><span style="font-family:""><span style="font-family:Verdana;">Maternal mortality remains a major concern in developing countries. This survey aims to suggest strategic plans that would help decrease maternal and perinatal mortality in the suburbs. It is a descriptive study that shows the different causes of maternal deaths during pregnancy and puerperium period. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">It is a retrospective descriptive study done between January 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> 2016 and the 31</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> of December 2018. We have collected information on all deaths due to mortality issues in Five (5) maternity clinics around Dakar. The record shows that teach centre have an average of 4000 deliveries per year. The data collected from the hospital records were inputted using Sphinx software (version 5). These data were analysed using Epi Info software (version 3.5). After analysing these data, recommendations were made to minimize the different causes of maternal deaths. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">We recorded 154 maternal deaths out of 32,420 live births. The direct causes of maternal deaths were a result of preeclampsia and its complications (31.2%), postpartum haemorrhage (24.7%), abruption placentae (20.8%) and obstructed labour (7.8%). The indirect causes were mainly sickle cell disease (1.3%), heart disease (1.3%) and gynaecological cancers (1.3%). Maternal deaths were also associated with fetal loss in 47.4% of 153 maternal deaths, need for blood transfusion 59% while none of the reference structures in the suburbs of Dakar has a blood bank;with a need for admission in intensive care unit was noted as 40%. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Thus, preeclampsia and its complications are the leading cause of maternal deaths in suburban settings. Timely availability of resuscitation units and liable blood products could drastically reduce maternal deaths from direct obstetric complications.</span></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“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<strong>Introduction: </strong><span><span><span style="font-family:""><span style="font-family:Verdana;">In Senegal, according to the 2017 Demographic Health Survey, </span><span style="font-family:Verdana;">about 22% of married women have an unmet need for family planning. Globally</span><span style="font-family:Verdana;">, 61% of women do not have access to postpartum family planning. </span><b><span style="font-family:Verdana;">Material </span><span style="font-family:Verdana;">and Method: </span></b><span style="font-family:Verdana;">This is a prospective, descriptive and analytical study from March</span><span style="font-family:Verdana;"> 05, 2017 to January 31, 2018. The interrogation was done in the hospital ward with filling in the data collection form. The data collected was first coded and then entered, using the sphinx software. The data analysis was done with Epi info version 7 software and included a descriptive and analytical component. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">The average age of the patients was 26 years with extremes of 15 and </span><span style="font-family:Verdana;">48 years. Average gestation was 2.3 with extremes of 1 and 8 pregnancies. More </span><span style="font-family:Verdana;">than half of the women (64.7%) had delivered by caesarean in an emergency setting. More than half of the women (66.7%) had chosen the hormonal contraceptive method within 48 hours of delivery and the implant was the type of </span><span><span style="font-family:Verdana;">contraceptive prescribed in almost half of the cases (49.3%). </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Integrating postpartum family planning into programs will ultimately help to dramat</span></span><span style="font-family:Verdana;">ically decrease high-risk pregnancies, decrease the </span><span style="font-family:Verdana;">unmet need for family plannin</span><span style="font-family:Verdana;">g (FP), and improve the health and survival of mothers and children.</span></span></span></span>
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 available, affordable and relatively safe.
文摘<strong>Introduction:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Cystic breast cancer is a rare entity. Breast cysts are most often benign. The clinical characteristics of malignancy are not specific. </span><b><span style="font-family:Verdana;">Objective:</span></b> <span style="font-family:Verdana;">To report a series of malignant cystic tumors of the breast and to describe</span><span style="font-family:Verdana;"> their different characteristics. </span><b><span style="font-family:Verdana;">Materials and Methods:</span></b><span style="font-family:Verdana;"> This was an observational study carried out between January 2018 and October 2021 at the Dakar </span><span style="font-family:Verdana;">university surgical oncology unit. We studied the clinical appearance, im</span><span style="font-family:Verdana;">ag</span><span style="font-family:Verdana;">ing, </span><span style="font-family:Verdana;">histopathology, extent of disease and treatment. We did not include cases of</span><span style="font-family:Verdana;"> pure, single, or multiple chronically progressive cysts. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> There were 8 </span><span style="font-family:Verdana;">patients, 6 women and 2 men. The average age was 44. All patients presented </span><span style="font-family:Verdana;">with a palpable unilateral deforming skin mass without inflammatory </span><span style="font-family:Verdana;">character. One patient presented with a bloody discharge. The cyst was</span><span style="font-family:Verdana;"> multilocular with</span><span style="font-family:Verdana;">out intracystic growth in 2 cases and presented a growth signal in 6 cases.</span> <span style="font-family:Verdana;">Imaging was ACR 3 in 5 cases and ACR 4 in 3 cases. Histopathology found 6</span><span style="font-family:Verdana;"> in</span><span style="font-family:Verdana;">va</span><span style="font-family:Verdana;">sive carcinomas including 2 papillary, 3 Invasive Carcinoma of No Special</span><span style="font-family:Verdana;"> Type (ICNST), 1 lobular carcinoma as well as one case of lobular carcinoma </span><i><span style="font-family:Verdana;">in situ</span></i><span style="font-family:Verdana;"> of the comedocarcinoma type in women and 2 ICNST in men. The extension </span><span style="font-family:Verdana;">workup was found in only 1 male patient in the presence of metastases.</span><span style="font-family:Verdana;"> Treatment included chemotherapy, mastectomy and radiotherapy for 6 of </span><span style="font-family:Verdana;">the patients. There wasn’t any complete response for invasive cases. Survival is 100% to date.</span><span> <b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Cystic breast tumors sometimes hide the cancer</span></span><span style="font-family:Verdana;"> that is difficult to diagnose. The prognosis seems favorable, however.</span></span></span></span>
文摘Objectives: The aim of our study was to investigate the relation of some sociodemographic factors and delays presentation in breast cancer. Patients and method: This was an observational study in Breast Unit of Aristide Le Dantec Teaching Hospital in Dakar. Were included in the study all patients followed for breast cancer from January 2008 to December 2014. The following variables were selected and stratified: age, place of living, educational attainment, menopausal status, socioeconomic status and family history of breast cancer. For each variable, an association with the stage and presentation delay was assessed. Results: Two hundred and fifty nine (259) patients met the inclusion criteria. No correlation was found between the studied socio-demographic factors and delay. Negative history of family breast cancer was associated with presentation delay. The only factor associated with locally advanced breast cancer after adjusting confounding factors was low level of income. Conclusion: A significant percentage of women with breast cancer in Senegal are experiencing presentation delay. Coordinated efforts with public health department are needed to educate the focused groups and mitigate the barriers.
文摘OBJECTIVES: 1) To draw up the epidemiological profile of patients who have benefited from cervical cancer screening by visual inspection after application of acetic acid (VIA) and then describe the results of the test, the colposcopy, histological and therapeutic aspects in case of dysplasia. 2) To evaluate the performance of IVA in cervical cancer screening and its feasibility in low-resource countries. MATERIALS AND METHODS: This was a prospective and descriptive study carried out from 06 June 2015 to 31 January 2016 (7 months) at the Maternity Center at Nabil Choucair health center in Dakar. The patients had been screened for cervical cancer by visual inspection, which consisted of applying 3% acetic acid after setting up a vaginal speculum. The test was considered positive if there were intense white areas in the cervix. Colposcopy was performed in case of a positive VIA result. This colposcopy included an unprepared examination, an examination after application of 3% acetic acid and an examination after application of Lugol solution. The colposcopic report is made according to the terminology of the French Society of Colposcopy and Cervico-Vaginal Pathology. Patients with major changes or unsatisfactory colposcopy had undergone diathermic loop resection. Surgical specimens were sent to pathologic anatomy and follow-up was performed according to the results of the histology. The studied parameters concerned the socio-demographic aspects, the results of the VIA test, the results of the colposcopy after a positive test, the therapeutic aspects in case atypical transformation zone grade 2 or of unsatisfactory colposcopy, the results of the histology after the conization and the followed. The collection of data was done thanks to a file and the statistical analysis thanks to the software Epi-info version 7. RESULTS: 899 patients were involved in the study. The epidemiologic profile of our patient was a multipara in a period of genital activity, aged 42.2 years with a mean gestational weight of 4.5, and a parity of 4. In our series, the patients had their first sexual intercourse with 20.8 years old. In our study, 84 patients (10.2%) had positive results after visual inspection after acetic acid applications. All patients with positive results after application of 3% acetic acid had colposcopy. In our study, 27 patients had major changes and/or unsatisfactory colposcopy and underwent diathermic loop resection for diagnostic and therapeutic purposes. Anatomo-pathological examination of the cone room revealed cervicitis in 22.2% of cases, flat condyloma in 7.4% of cases, CIN2 in 22.2% of cases, and CIN3 in 18.5% of cases. All the conizations were in sano. The postoperative course was simple. CONCLUSION: Cervical cancer is a real public health problem in developing countries. To do to human resources, developing countries like Senegal must put in place simple, inexpensive, effective strategies that must globally respond to “screen and treat”.
文摘Objectives: To evaluate a medical data management system of a mammogram unit in a department of Radiology. Methods: This is a qualitative and quantitative assessment study in Fann Teaching Hospital between April 2014 and June 2015 one year after its implementation. The quantitative component consisted of the audit of the database to determine the socio-demographic characteristics of patients and the results of mammograms. The qualitative component assessed users’ experience. For analysis, quantitative data were extracted and transferred to Microsoft Excel. For scale variables, we calculated the averages and extremes. For qualitative variables, we established percentages. Results: During the study period, 433 patients underwent mammograms. The average age of patients was 48 years. The completion rate maintained above 85% was below 26% in the first two months of use. As to the completeness given examinations, it was still above 83%. The results of mammogram examinations were normal in the majority of cases: 96% for the right breast and 95.2% for the left breast. All users had a favourable opinion about the database. The reasons were better work organization, comprehensiveness, accessibility and standardization of information about the patient and especially the immediate availability of statistics. For 60% of these health professionals, complaints related to the use of the software were the time-consuming of filling data. Conclusion: This study mainly describes the perception of health professionals on the computerization of radiological examinations. It offers some advantages, proposes improvements and opens avenues for reflection on the globalization of the computerization of patient records in Radiology.
文摘Objectives: The aim of this study was to analyse key factors and main indications of primary caesarean sections and find out ways to reduce the rising rates. Patients and method: This was a longitudinal and retrospective study carried out from 1 January 2012 to 31 December 2016. The study included all patients in whom a primary CS was performed. A previous uterine scar was a non-inclusion criterion. We analysed the main indications and their trends during these five years, Apgar score at the 5th minute according to the course of caesarean section rate and the impact of daily audit. Data were collected retrospectively from 2012 to 2015, then prospectively in 2016 using a Filemaker database. Data were analysed with SPSS 21 software, Mac version. Averages were calculated for quantitative data and percentage for qualitative ones. The statistical tests used were the Pearson Chi2 test. The differences observed were considered significant when the p value was less than 0.05. Results: During the study period, we registered 21.308 deliveries and 6.292 caesarean sections (29.5%). Primary CS concerned 72.5% of overall CS. The main indications were suspicious of fetal distress (29.1%), obstructed or prolonged labour (21.7%), breech and twin delivery with respectively 8.2% and 5.2%. We registered more vaginal deliveries with induction of labour: 81.4% versus 75.2%. An obstetrical audit allowed better management of labour and decrease of CS rate. Conclusion: We need to focus on diagnosis of fetal distress, management of breech presentation in twin delivery and singleton. The induction of labour can be an effective alternative in some indications. An obstetrical audit is necessary to reverse caesarean section rate.
文摘Objectives:?Investigating the relation between perinatal outcomes and?hospital working shifts.?Methods:?We conducted a cross-sectional study at Philippe Maguilen Senghor health center (PMSHC) in Dakar, Senegal from January, 1st?2011 to December, 31th 2018. The study population was comprised of all mothers who had delivered at PMSHC and their newborns after completing 22 weeks of gestation. Time of delivery was?divided into three periods of working hours: morning shift (deliveries occurred between 7 am and 4:59 pm);evening shift from 5 pm to 10:59 pm and night shift from 11?pm to 6:59 am.?Maternal outcomes were assessed by mode of delivery, epsisotomy and perineal injuries.?The Apgar scoring system was used to assess newborns at first minute after they were born. Other adverse perinatal outcomes included fresh stillbirth, neonatal referral and early neonatal death. Data were analyzed using Statistical Package for Social Science software (SPSS 24, Mac version).?Results:?A total of 48,270 mothers and their newborns met eligibility criteria. Caesarean section deliveries were less likely to occur during evening (OR 0.84, 95% CI;0.79?-?0.89, p = 0.001) and night shifts (OR 0.45, CI;0.47?-?0.53, p = 0.001).?Evening shift deliveries had 1.1 the odds of poor perinatal outcome (Apgar score ?- 1.18, p = 0.012). No significant difference was found in the odds of neonate referrals and deaths across the three shifts.?Night shift deliveries had 1.1 the odds of perineal injuries compared to morning shift deliveries (OR 1.11, 95% CI;1.04?- 1.18, p = 0.001, for episiotomy and OR, 1.14;95% CI, 1.04?- 1.26, p = 0.008, for perineal tears). Conclusion:?Off-hours deliveries, particularly during the night shift, were significantly associated with higher proportions of perineal injuries compared to morning shift.?However, no significant difference was found in the odds of neonate referrals and deaths across the three shifts.?Our findings suggest to set up a Neonatology unit at the CSPMS as well as a perinatal network across the country.
文摘Objective: To assess a training approach in Emergency Obstetric and Neonatal Care (EmONC) to strengthen skills of healthcare providers and reduce maternal mortality. Materials and methods: The approach was based on the skills training using the so-called “humanist” method and “life saving skills”. Simulated practice took place in the classroom through thirteen clinical stations summarizing the clinical skills on EmONC. The evaluation was done in all phases and the results were recorded in a database to document the progress of each learner. Results: We trained 432 providers in 10 months. The increase in technical achievements of each participant was documented through a database. The combination of training based on the model “learning by doing” has ensured learning and mastering all EmONC skills particularly postpartum haemorrhage management and reduced missed learning opportunities. Conclusion: The impact of training on postpartum haemorrhage management and maternal mortality is a major challenge in terms of prospects.
文摘Objective: Describe the design and implementation of an electronic medical record—E-INTMED—customized for Internal Medicine in Dakar, Senegal. Methodology: This study was carried out in a public teaching hospital in Dakar Senegal. It entailed collaboration between physicians specialized in various fields in Internal Medicine and Computer Scientists to carry out the compilation of data and their electronic transcription to produce a prototype which met users’ needs. Results: E-INTMED software is structured around several hierarchical tables allowing users to register and store all relevant patients’ information. E-INTMED structures patient’s data to provide a clear overview of their medical history and users’ activity performance. E-INTMED makes medical users’ life so much easier. Users can generate and send letters and prescriptions quickly and efficiently using the customized templates which they can modify or create new ones. In addition to these capabilities, all of the features expected in an Internal Medicine EHR are handled by E-INTMED, such as lab orders and results, mechanisms for continuity of care, embedding and access to images and documents, and so much more. E-INTMED provides medical students with a number of educational, practical and administrative advantages. Conclusion: Computerization of medical records has become a necessity today. Crossing the line to Electronic medical records could help to improve medical practice and medical training.
文摘Objectives: To evaluate the prognosis of obstetric complications by parity in a suburban center in Dakar. Patients and Method: We conducted a retrospective and prospective, cross-sectional study that evaluated all women admitted to the Philippe Maguilen Senghor Health Center for the management of their pregnancy (childbirth, abortion, ectopic pregnancy), whether they were primiparous or multiparous. The data for this study covered a 66-month period, from January 1, 2012 to June 30, 2017. Data were entered into our E-perinatal computer database. They were then extracted and analyzed first on Microsoft Excel 2016 and then on SPSS 24, Windows version. Results: Between January 2012 and June 2017, we’ve registered 27,441 patients including 25,905 deliveries, 1415 abortions and 121 ectopic pregnancies. Direct obstetric complications involved 14.1% of our patients. 12.1% multiparous and 17.3% primiparous had at least one direct obstetric complication of World Health Organization (WHO). Antepartum haemorrhage, uterine rupture, ectopic pregnancy, and abortion complications were more common in multipara, whereas prolonged and obstructed labor, preeclampsia, and eclampsia were more common in primiparous women. Postpartum haemorrhage occurred at substantially equal frequencies in both parity groups. We had not found any case of sepsis. Conclusion: Our study confirms that primiparity is a factor that may lead to obstetric complications. However, while some complications were more common in the primiparous, others were exclusive to multiparous when we did not expect it. We also recommend continuing this work by singling out multiparas and large multiparas, in order to better understand the obstetric prognosis linked to parity.
文摘Objectives: To assess the quality of the obstetric evacuation system at the Youssou Mbargane Diop Hospital in Dakar. Methods: Our study was conducted at the Hospital of Youssou Mbargane DIOP in Rufisque, a district about 26 km from downtown Dakar. This was a qualitative and evaluative descriptive study in the form of operational research aimed at improving the quality of obstetrical evacuations and resolving problems through a dynamic and team approach. It was carried out within the framework of the AQUASOU project (Improvement of Quality and Access to Emergency Obstetric Care in French). A liaison sheet was completed at the arrival of each evacuated patient, prospectively during the period from December 24 2006 to July 10 2008. The epidemiological characteristics were, origin of the evacuated, the evacuation conditions, evacuation patterns and therapeutic data. The data were collected through an Excel database developed for this purpose. The analysis was done using the Epi-Info version 6.0 software. Results: The frequency of evacuations was 23.2%. The average age of our patients was 25.3 years with extremes of 14 years and 48 years. More than half of the evacuees (59%) came from the Sanitary District of Rufisque. The majority of evacuations were made in a taxi (76.5%). An ambulance was used in 190 cases (20.6%). Seated transport was performed in 78% of cases. The transfer was medicalized in almost one-third of cases (29.3%). A liaison sheet was established during the transfer of patients in 77% of the cases. Evacuations were related to hemorrhage in 23.3%, dystocia in 22.2%, and fetal-adnexal anomaly in 17.3% of cases. No treatment was instituted before evacuation in 56% of evacuees. 48.5% of the evacuees had received treatment beyond. Conclusion: The poor quality of obstetric evacuations seems to be a brake on the decline in maternal and neonatal mortality in Senegal. Training and retraining of health personnel would improve maternal-fetal and neonatal morbidity and mortality.
文摘The counter-referral system is particularly important for care during pregnancy, childbirth and the post-partum period as it facilitates access to emergency obstetric and neonatal care. It allows people to access care that is not likely to be provided at the base and to manage certain complications arising in emergency settings. We therefore looked at the evaluation of obstetric evacuations from the Touba Ndamatou public health. Methodology: This was a retrospective study of descriptive and analytical type extending over a period of 12 months from January 1, 2020 to December 31, 2020 at the public hospital health establishment (PHHE) of Touba Ndamatou. Results: One thousand five hundred and sixty (1560) patients evacuated for obstetrical reasons were collected out of a total admission of 5560, i.e., a frequency of 28%. The average age of the patients was 25.54 years. The mean gestation was 3.24 pregnancies. The average parity was 3.04 deliveries. Almost all of our patients (99%) were married. Slightly more than one in two women (53.6%) had performed at least 2 or 3 Prenatal consultations. 80% of parturients had traveled a distance of less than 20 km. 623 patients came by their own means (54.6%). Evacuation was provided by an ambulance in 509 patients, i.e., 44.6%. Arterial hypertension and its complications were the frequent reason for evacuations with approximately one in four patients (26.2%). Only 3.6% of patients had qualified personnel on board being evacuated. In our series, 13 deaths were recorded, i.e., 1.1% of cases. The distance traveled seemed not to influence the future of the mother (p = 0.51). The non-accompaniment of the patient during the evacuation by a medical staff seemed to influence the prognosis of the mother (p = 0.031). Fetal morbidity was higher among evacuees not accompanied by medical personnel. The state of apparent death was observed in the majority of cases in patients received over a distance of more than 20 km. Conclusion: Evacuation requires a clear definition of the roles and responsibilities of each level of the health pyramid, good organization in the health structures as well as within the community, and a good information system.
