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Reasons for Elective Surgery Cancellations in a Senegalese Pediatric Surgery Department

Open Journal of Pediatrics 2024年第5期14卷 783-789页

作者： Cheikh Tidiane Mbaye Cheikh Diouf Florent Tshibwid A Zeng Faty Balla Lô Lissoune cissé doudou Gueye Ibrahima Bocar Wellé Souleymane Camara Papa Alassane Mbaye Oumar Ndour gabriel Ngom Department of Pediatric Surgery Aristide Le Dantec University Teaching Hospital Universit Cheikh Anta Diop Dakar Senegal Department of Pediatric Surgery Ziguinchor Regional Hospital Center Universit Cheikh Anta Diop Ziguinchor Senegal Department of Pediatric Surgery El Hadj Ibrahima Niass Regional Hospital Center Kaolack Senegal Department of Pediatric Surgery Pikine National Hospital Center Dakar Senegal Department of Pediatric Surgery Albert Royer National Childrens Hospital Center Universit Cheikh Anta Diop Dakar Senegal Unit of Pediatric Surgery Department of Pediatrics Dalal Jamm National Hospital Center Dakar Senegal

Introduction: Cancellation of elective surgery is common in developing countries. This decision is difficult to make as it generates economic and organizational consequences for the healthcare facility and an additional source of stress for patients and their caregivers. This study aimed to analyze the various aspects of this medical problem. Patients and Methods: We conducted a prospective and descriptive study over six months (from January 1st, 2017, to June 30th, 2017) at the pediatric surgery department of Aristide Le Dantec University Teaching Hospital in Senegal. Results: Ninety-one cases were collected. The cancellation rate was 20.8%. Infants were affected in 36.3% of cases. among anesthesiologists, 83.5% were residents, and 16.5% were specialists. Cancellation in nephroblastoma children with an indication for extended nephrectomy represented 15.4% of cases. Concerning reasons for cancellation, comorbidities, dominated by respiratory infections, accounted for 28.5% of cases, patient absences for 24.2%, and issues related to the anesthesiologist for 17.6%. Cancellations were avoidable in 33% of cases. Patients were responsible for cancellation in 37.4% of cases, the healthcare system in 33%, and medical reasons in 29.7%. Conclusion: Our findings suggest that one-third of cancellations could have been avoided with improvements in the healthcare system. Actions should be taken to reduce the cancellation rate in our context.

关键词： Cancellation Elective Surgery Pediatric Surgery LMICs Senegal

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Management of Acute Myeloblastic Leukaemia (amL) Treated with Intensive Chemotherapy: Experience in a Single Centre

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Open Journal of Pediatrics 2024年第2期14卷 401-411页

作者： Abdoul Karim doumbia Hawa Konaré Tati Simaga Pierre Togo Oumoulkairi Nana Kouma Hawa Gouro Diall Oumar Coulibaly Adama Dembélé Mohamed Elmouloud cissé Karamoko Sacko Belco Maiga aminata doumbia Kalirou Traoré Ibrahima cissé Boury Traoré Abdoul Aziz Diakité Fousseyni Traoré Boubacar Togo Department of Pediatrics University Hospital Gabriel Touré Bamako Mali

Introduction: Acute myeloblastic leukaemia (amL) is a haematological malignancy with a poor prognosis, despite significant therapeutic progress. This study presents the results of amL management in Mali according to GFAOP recommendations. Methodology: This was a retrospective, cross-sectional study. It included patients aged 0 - 15 years treated in the paediatric oncology unit for amL and followed up between January 2016 and December 2020. Results: During the study period, 85 cases of acute leukaemia were diagnosed in the paediatric oncology unit (including 51 cases of ALL), of which 34 cases of amL were included in this study. The majority were boys (59%). The mean age was 8 years, with extremes of 18 months and 15 years. The mean time to diagnosis was 68 days. In 79% of cases, patients were referred by 1st or 2nd level hospitals. Anaemia was observed in 91% of cases, an infectious syndrome in 68%, haemorrhage in 56% and a tumour syndrome in 85%. The haemogram showed hyperleukocytosis in 15% of cases, thrombocytosis in 22% and severe anaemia in 73%. Death occurred in 85% of cases, most often in the context of sepsis or haemorrhage. Conclusion: amL is probably underestimated in Mali and diagnosis delayed, which may be explained by patient-related factors (lack of knowledge, financial constraints) and a cumbersome referral system. These results suggest the need to implement an appropriate diagnostic and therapeutic strategy, with strong involvement of the political authorities.

关键词： Acute Myeloblastic Leukaemia Children Mali

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Early Prosthetic Valve Endocarditis with Mycobacterium Tuberculosis after Mitral Valve Replacement: A Case Report

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World Journal of Cardiovascular Surgery 2024年第3期14卷 33-40页

作者： Papa amath Diagne Mory Camara Papa Ousmane Ba Momar Sokhna Diop Moussa Samba Abdou Lahad Mbengue Jean Claude Ndiogou Dione Myriam Bizrane Marième Soda Mbaye Moussa Seck Diop Toudiani Malam Kaka Papa Salmane Ba Papa Adama Dieng am.dou gabriel ciss Assane Ndiaye Cardiovascular and Thoracic Surgery Department FANN National University Hospital Dakar Senegal

Background: Tuberculous endocarditis is a rare but serious complication of heart valve replacement surgery. We report the case of a 24-year-old patient, who presented with tuberculous endocarditis after mechanical mitral valve replacement, with a favorable clinical course following anti-tuberculosis treatment. Case Presentation: We report a 24-year-old male patient, admitted to the cardiac surgery department of the Fann Hospital (Dakar, Senegal), for the management of severe mixed (rheumatic and endocarditic) mitral insufficiency with associated tricuspid insufficiency. He had a history of recurrent angina and polyarthralgia in childhood, was hospitalized several times for refractory global cardiac decompensation, and for a suspected infective endocarditis a month before his admission. On admission, the clinical examination revealed signs suggestive of mitral and tricuspid insufficiency. Transthoracic echocardiography revealed severe post-endocarditic mitral insufficiency with A3 amputation, highly mobile 15 mm vegetations on the free edge of the large valve, moderate tricuspid insufficiency, and severe pulmonary artery hypertension. Mechanical mitral valve replacement and tricuspid valve annuloplasty using autologous pericardial strip were performed via median sternotomy. After ten days, the patient presented with global cardiac decompensation associated with a clinico-biological infectious syndrome, and tans-oesophageal echography revealed an abscess at the sinotubular junction, communicating with the aorta. A thoraco-abdomino-pelvic CT scan was done, which revealed a bilateral alveolar-interstitial syndrome with mediastinal lymphadenopathy. Anti-tuberculosis treatment with RHZE was initiated for 06 months. The clinical course was favorable. Conclusion: Tuberculous endocarditis in prostheses is a serious complication of heart valve replacement surgery, which may evolve favorably under medical treatment.

关键词： Tuberculous Endocarditis Prosthetic Valve Endocarditis Mycobacterium Tuberculosis

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Cervical Meningocele about 2 Operated Cases

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Open Journal of Modern Neurosurgery 2024年第1期14卷 1-7页

作者： Mohamed El Hassimi cissé Mam.dou Salia Diarra N’Famara Sylla Abdoulaye Diop Izoudine Blaise Koumaré Théodore Habib Maxime Coulibaly Oumar Diallo Drissa Kanikomo Neurosurgery Department of CHU Mère-Enfant “Le Luxembourg” Bamako Mali Neurosurgery Unit of Army Medico-Surgical Center of Bamako Bamako Mali Neurosurgery Department of CHNU de Fann Dakar Sénégal Neurosurgery Department of CHU Hospital du Mali Bamako Mali Neurosurgery Department of CHU gabriel Touré Bamako Mali

Cervical meningoceles are the least common forms of spina bifida, representing between 4% to 8% of all spinal dysraphisms. They are not accompanied by neurological deficit in childhood but attached cord syndrome can occur with growth. Surgical treatment, in addition to avoiding rupture and correcting the aesthetic damage, will preserve neurological functions. We report 2 cases that we took care of. They are a 5-month-old infant and a 3-year-old girl. The first presented a 7 cm rounded meningocele pedunculated through the C1 lamina defect. The second presented an 8.6 cm polylobed meningocele pedunculated through the C2 lamina defect. They both underwent surgery with good progress.

关键词： Cervical Meningocele Spinal Dysraphism Spina Bifida

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Results of the First 10 Cases of Coronary Bypass Surgery in Senegal

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World Journal of Cardiovascular Surgery 2024年第4期14卷 45-60页

作者： Papa amath Diagne Jean Claude Ndiogou Dione Papa Ousmane Ba Momar Sokhna Diop El Hadji Boubacar Ba Momar Dioum Marième Soda Mbaye Moussa Seck Diop Mory Camara Abdou Lahad Mbengue Abdou Aziz Thiaw Abdoul Khoudoss Diallo Moussa Mareme Samba Dialtabé Ibrahima Guéssé Ba Anta Mbaye Sall Papa Salmaneba am.dou gabriel ciss Department of Cardiovascular and Thoracic Surgery FANN National University Hospital Dakar Senegal

This is a review of the first 10 coronary artery bypass surgeries performed by the local team. The mean age was 62 years old [45 - 74]. The patients were predominantly male, with a M/F ratio of 4:1. Cardiovascular risk factors were mainly myocardial infarction (MI) (60%), hypertension (50%), obesity (40%) and diabetes (30%), with at least two risk factors per patient. Angina was the main symptom (80%). The average time from presentation to surgery was 8 months. The mean Euroscore 2 was 2.92 ± 1.65 [1.33 - 6.60]. Coronary angiography revealed an average of 2 lesions per patient, with 3-vessel involvement in 70% of cases: the Interventricular artery (IVA) (100%), the right coronary artery (90%) and the circumflex artery (70%). On echocardiography, the mean Left ventricular ejection fraction (LVEF) was 59% [33% - 76%]. All patients underwent median sternotomy with bypass grafting. The average duration of the cardiopulmonary bypass was 150 min [46 - 275 min];that of aortic clamping, 120 min [43 - 232 min]. The grafts used were internal thoracic artery (ITA) in 100% of cases (80% on the left and 20% on the right), and the great saphenous vein (GSV) in 60% of cases (50% on the left and 10 on the right). double bypass was performed in 60% of cases, single bypass in 30% and triple bypass in 10%. The bypasses were performed on the IVA (100%), the middle lateral of the circumflex (30%) and the bisector (20%). The average time to extubation was 11 hours and the length of stay in the intensive care unit was 7 days [03 - 17 days]. One patient had a reoperation on Day 0 post-op. The average hospital stay was 13 days [06 - 27 days]. Complications occurred in nine of the patients (90%), with a predominance of infectious and neurological complications. Overall operative mortality was 3%, all in intensive care.

关键词： Coronary Bypass Surgery Coronary Lesions Cardiac Surgery Senegal

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Therapeutic Profile and Prognostic Factors of Patients Suffering from Upper Digestive Bleeding at Sikasso Regional Hospital

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Open Journal of Gastroenterology 2024年第9期14卷 300-312页

作者： Oumar Traoré Abdoul Salam Diarra Dramane Touré Tawfiq Abu am.dou Boubeye Maïga Kadiatou cissé Saïdon Touré Mohomedine Touré Aboudou Dolo Youana Koné Madou Traoré Mam.dou Togo Kalba Péliaba Mam.dou Samaké Ham.doun Sangho Service of Internal Medicine Regional Hospital Sikasso Mali National Center for Scientific and Technological Research Bamako Mali Department of Pediatric Health Referral Center of Kalaban Coro Koulikoro Mali Private Practice for Family and Emergency Medicine Casablanca Morocco Service of Nephrology Regional Hospital Sikasso Mali Department of Infectious Disease Regional Hospital Sikasso Mali Service de Mdecine Interne CHU Gabriel Tour Bamako Mali Service dHpato-Gastro-Entrologie CHU Gabriel Tour Bamako Mali Department of Public Health Faculty of Medicine and Odontostomatology University of Sciences Techniques and Technologies of Bamako Bamako Mali

Introduction: Upper digestive hemorrhage is one of the main digestive emergencies and remains a major cause of morbidity and mortality in Mali. The aim of this study was to describe the therapeutic profile and outcome of patients suffering from upper digestive haemorrhage. Methodology: This was a prospective study carried out in the internal medicine department of the Sikasso Regional Hospital from August 2022 to July 2023. All adult patients presenting with upper digestive haemorrhage and having given their consent, were included. Data were analyzed using SPSS version 21 software. Results: Sixty-three patients were enrolled. The mean age was 49.7 ± 18.99 years, with a male-female sex ratio of 2.2. Ruptured esophageal varices (37.5%) and peptic ulcer (25%) were the main etiologies. Pharmacological treatment was dominated by proton pump inhibitors (85.7%). Hemostasis endoscopy accounted for 3.17%. The evolution was marked by hemorrhagic arrest (69.84%), recurrence of hemorrhage (11.11%) and death (19.04%), the main cause of which was hemorrhagic shock (58.3%). We found no statistically significant relationship between prognosis and etiologies (P = 0.11), and length of hospital stay (P = 0.18). Conclusion: Hemostasis endoscopy remains a challenge for Sikasso Hospital. A holistic strategy of communication and community awareness-raising, combined with adequate technical facilities, will help to improve patient care and outcomes.

关键词： Digestive Hemorrhage Digestive Endoscopy Treatment Outcome

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Epidemiological Approach to Understand Rheumatic Heart Valve Disease: Case of Thoracic Cardiovascular Clinic of Fann Hospital (Dakar)

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World Journal of Cardiovascular Diseases 2020年第10期10卷 750-760页

作者： Marie Parsine Sall Fatimata Mbaye Mbacké Sembéne am.dou gabriel ciss Département de Biologie Animale Faculté des Sciences et Techniques Université Cheikh Anta Diop Dakar Sénégal Institut de Recherche Pour le Développement Campus Bel-Air Université Cheikh Anta Diop Dakar Sénégal Faculté de Médecine de Pharmacie et D’odontologie Université Cheikh Anta Diop Dakar Sénégal

Objective: Rheumatic heart disease is the major cause of heart valve disease in developing countries. In Senegal, cardiac pathology is dominated by rheumatic pathology whose hospital prevalence was estimated at 0.15% [1]. Epidemiological data on rheumatic heart valve disease (RHVD) are unfortunately imprecise due to the lack of good quality data collection in a large number of countries, especially in sub-Saharan areas and in Central Asia. The objective of this epidemiological study is to collect data about rheumatic heart valve disease in our clinic which is the only surgical center of Senegal. Patients and Methods: Our study conducted between 2014 and 2017 involved a population of one hundred and eighty-three patients with complete medical records, all followed at the Thoracic and Cardiovascular Surgery Clinic at Fann Hospital for rheumatic valve disease. This population was the subject of an epidemiological survey based on a questionnaire covering clinical parameters as consanguinity, clinical signs, diagnosis and surgical intervention. Results: Our work is an epidemiological study involving one hundred and eighty-three (183) patients with various types of rheumatic valve disease, followed at the Thoracic and Cardiovascular Surgery Clinic at Fann Hospital, and who responded to a questionnaire about clinical aspects of this disease. Our results showed 5.46% of family cases, of which 2.18% came from consanguineous marriages. Mean age at onset of clinical signs was 14 amily:;" "="">± 9 years with 14.20% before 6 years of age, 65.91% between

关键词： Rheumatic Valves Epidemiological Diagnosis Surgery

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Evaluation of Antibiotic Prescribing in the Pediatric Department of gabriel TouréTeaching Hospital, Bamako, Mali

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Open Journal of Pediatrics 2024年第3期14卷 645-656页

作者： Pierre Togo Hawa Konaré Mariam Maïga Karamoko Sacko Djénéba Konaté Abdoul Karim doumbia Adama Dembélé Oumar Coulibaly aminata Sangaré Mohamed Elmouloud cissé Fousseyni Traoré Belco Maïga Ibrahim Aham.dou aminata doumbia Lala N’Drany Sidibé am.dou Touré Yacouba Aba Coulibaly Kalirou Traoré Tati Simaga Souleymane Sagara Leyla Bagna Maïga Bory Traoré Abdoul Aziz Diakité Fatoumata Dicko Mariam Sylla Sounkalo Dao Boubacar Togo Paediatric Department Gabriel Tour&#233 Teaching Hospital Bamako Mali Pediatric Department Distric VI Reference Health Center Bamako Mali Infectious Diseases Department Point G Teaching Hospital Bamako Mali

Objectives: The main objective was to evaluate antibiotic prescribing in the Department of Pediatrics at gabriel Touré teaching hospital. Methods: This was a prospective descriptive study conducted from September 1 to November 31, 2018, in the Department of Pediatrics at gabriel Touré teaching hospital. All children aged 0 to 15 years hospitalized for any pathology during the study period and having received at least one antibiotic had been included. Results: We collected 445 children’s records out of 1032 admissions during the study period, representing a hospital frequency of 43.1%. The sex ratio was 1.3%. The 2 - 5 age group accounted for 48.1%. Fever was the reason for consultation in 45.6% of cases. Patients’ general condition was altered in 60% of cases. The fathers were blue-collar workers in 65.4% and the mothers housewives in 85%, and had no education in 42.9% and 64.5% respectively. Hepatomegaly was present in 18.2%, splenomegaly in 9.6% and peripheral adenopathy in 3.1%. The site of infection was pulmonary in 37.6% and ENT in 9.2%. Bacterial infection was assumed on admission in 54% of cases, and meningitis in 57.7%. The discharge diagnosis was malaria in 54.6%, severe acute malnutrition in 18.6% and meningitis in 6.7%. The death rate was 3.8%. Neutrophilic leukocytosis was present in 47.3% of patients. CRP was positive in 85% of patients. Blood cultures taken in 27.6% of patients were positive in 5. CSF analysis in 30% of patients showed elevated leukocytes in 6.5%. No cultures were positive. Antibiotic prescription was justified by infectious hypotheses in 43.1% of patients. β-lactam antibiotics were prescribed in 98.6%. Antibiotic therapy was not adapted to national/international recommendations in 68.3% of cases, and was not justified in 16.3% of cases on D5 of hospitalization. Conclusion: Antibiotic use was justified in more than half of patients, but remained inadequate in almost two-thirds of cases, in line with national and international recommend

关键词： Antibiotic Prescription Hospitalization Child

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Surgical Treatment of Tetralogy of Fallot with Pulmonary Valve Agenesis in a 22 Years Old Patient

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World Journal of Cardiovascular Surgery 2021年第4期11卷 29-36页

作者： Papa Salmane Ba Kabulo Yannick Momar Sokhna Diop Papa amath Diagne Ndeye Fatou Sow Papa Adama Dieng am.dou gabriel ciss Thoracic and Cardiovascular Surgery Department CHU Fann Dakar Senegal

Agenesis of pulmonary valve is a rare variant and severe form of Tetralogy of Fallot (ToF). The evolution is usually marked by respiratory and cardiac failure at early age, which needs early surgical correction. Uncorrected treatment of Tetralogy of Fallot diagnosed at adult age is infrequent and only few studies have been described. We present here a rare case of a 22 years old patient who presented with dyspnea since childhood. Subsequent investigations allowed diagnosis of treatment of Tetralogy of Fallot with agenesis of the pulmonary valve. Following the assessment, the patient underwent a surgical repair and the recovery was uneventful. The management of treatment of Tetralogy of Fallot with pulmonary valve agenesis in adult period remains complex, requiring different surgical techniques.

关键词： Tetralogy of Fallot Pulmonary Valve Agenesis Adult Surgical Repair

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Atrioventricular Septal Defect with Intact Interatrial Septum. Case Report

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World Journal of Cardiovascular Surgery 2020年第8期10卷 143-149页

作者： Papa Salmane Ba Yacouba Tamboura Momar Sokhna Diop Papa amath Diagne Ndeye Fatou Sow Papa Adama Dieng am.dou gabriel ciss Thoracic and Cardiovascular Surgery Departement CHU Fann Dakar Senegal

In atrioventricular septal defect (AVSD), anatomical lesions usually are an ostium primum atrio-septal defect;a common atrioventricular valve, an inlet ventricular septal defect (VSD). It is most often associated with major chromosomal abnormalities. It is the most common congenital disease in Down syndrome. Our case was an infant with a Down syndrome who was admitted for a dyspnea (stage 3 in New York Heart Association classification) and tachycardia. The diagnosis was made by a transthoracic echocardiography. It showed a rare variety of atrioventricular septal defect without an atrial septal defect. The child was treated successfully with one patch technic and no recurrence was noted.

关键词： AVSD VSD Dyspnea Transthoracic Echocardiography Patch

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