ABSTRACT
INTRODUCTION: Mental health is a state of equilibrium and well-being, any alteration of which leads to the appearance of a state of distress and/or mental disorder. OBJECTIVE: The objective of this work was to study familial and environmental factors associated with mental disorders. MATERIALS AND METHODS: A cross-sectional study was conducted in the Psychiatry Department of the Point G University Hospital Center from April 1, 2016 to March 31, 2017 among outpatients with a psychiatric disorder in whom factors associated with psychiatric disorders were studied. RESULTS: We included 288 patients. The median age was 33.0 years. The sex ratio was 1.88 in favor of males. Married patients accounted for 45.5%. First born uterine siblings accounted for 26.7%. Patients born of an inbreeding alliance accounted for 25.7%. Cases with a family history of a psychiatric disorder represented 59.0% and those who spent their childhood with their parents accounted for 64.2%. Cases of psychoactive substance use prior to the onset of the mental disorder accounted for 42.7%. The main psychosocial stress factors that preceded the onset of the mental disorder were grief (46.2%) and family conflict (22.6%). Psychotic disorders accounted for 77.8%. CONCLUSION: Our results show an association of mental disorders with family history of psychiatric disorder among patients followed in psychiatry. Further studies, such as genetic association may prove useful.
Subject(s)
Mental Disorders , Psychotic Disorders , Adult , Child , Cross-Sectional Studies , Hospitals, University , Humans , Male , Mali/epidemiology , Mental Disorders/epidemiologyABSTRACT
INTRODUCTION: The objective of this work was to determine the frequency of mental disorders among female inmates of the C.S.D.R.F "Bollé". METHOD: This was a descriptive, cross-cutting, prospective study that took place from August to September 2016 at (C.S.D.R.F) "Bollé" in Bamako. It concerned all female inmates present during the study period. The data were collected from pre-established fact sheets, the administration of the Mental Health Screening Questionnaire (MSQ) and clinical variables according to ICD10 criteria. RESULTS: In total, 85 of inmates, or 74% (N-115) agreed to participate in the study. The 14-24 age group accounted for 61.0%. Singles accounted for 56.5% and 95.3% of female inmates had no previous prison history. Seventy-four percent were in pre-trial detention 12.6% had psychotic disorders. Personality disorders were observed in 11.8%. An inmate was on the committee. Thyme disorders were present in 4.7% of female inmates. Drug abuse was observed in 2.4% of female inmates. CONCLUSION: Detention can trigger, promote or aggravate a mental disorder.
INTRODUCTION: L'objectif de ce travail était de déterminer la fréquence des troubles psychiques chez les détenues du C.S.D.R.F « Bollé ¼. MÉTHODE: Il s'agissait d'une étude descriptive, transversale, prospective qui s'est déroulée d'Août à Septembre 2016 au (C.S.D.R.F) « Bollé ¼ de Bamako. Elle a concerné toutes les détenues présentes pendant la période d'étude. Les données ont été collectées sur des fiches d'enquête préétablies, l'administration du Questionnaire de Dépistage en Santé Mentale (QDSM) et des variables cliniques selon les critères du CIM10. RÉSULTATS: Au total, 85 détenues, soit 74 % (N=115) ont accepté de participer à l'étude. La tranche d'âge de 14-24 ans représentait 61,0%. Les célibataires représentaient 56,5% et 95,3% des détenues étaient sans antécédent carcéral. Soixante quatorze pourcent (74%) étaient en détention provisoire 12,6% présentaient des troubles psychotiques. Les troubles de la personnalité étaient observés chez 11,8%. Une détenue présentait la comitialité. Les troubles thymiques étaient présents chez 4,7% des détenues. L'usage abusif de drogue avait été observé chez 2,4% des détenues. CONCLUSION: La détention peut déclencher, favoriser ou aggraver un trouble psychique.
ABSTRACT
OBJECTIVES: the purpose of this work was to describe the epidemiological, clinical, paraclinical and therapeutic aspect of surgical treatment of chronic osteomyilitis of limbs. PATIENTS METHODS: it was a retrospective study over a period of 12 years, from January 2003 to December 2014. It covered all cases of chronic osteomyelitis osteonecrosis treated our service. RESULTS: The authors report the results of the surgical treatment of a series 56 patients operated on for chronic limb osteomyelitis. The mean age was 20.7 years with extremes of 6 months and 56 years. The tibia and femur were the most affected segments. Staphylococcus aureus was the most frequently found germ, 80% of the cases. We obtained complete healing with total cure in 68% of cases and recurrence of suppuration in 32% of cases. CONCLUSION: Chronic osteomyelitis of limbs is a frequent pathology in Africa. Staphylococcus aureus was the most frequently found germ. Surgery in a time seems a good alternative. The rate of recurrence of the suppuration remains high.
OBJECTIF: Le but de ce travail était de présenter les aspects épidémiologiques, cliniques, bactériologiques, radiologiques et thérapeutiques des ostéomyélites chroniques des membres. MÉTHODES: Nous avons réalisé une étude rétrospective sur une période de 12 ans allant de Janvier 2003 à décembre 2014. Elle a porté sur tous les cas d'ostéomyélites chroniques pris en charge chirurgicalement dans notre service. RÉSULTATS: Nous avons recensé 56 cas d'ostéomyélite chronique des membres. L'âge moyen était de 20 ans avec des extrêmes de 6 mois et 56 ans. Le sex-ratio était de 1,9. Le tibia et le fémur ont été les os les plus atteints. Staphylococcus aureus a été le germe le plus fréquent soit 80% des cas. Nous avons obtenu la cicatrisation parfaite de la plaie dans 68% des cas et la récidive de la suppuration dans 32% des cas. CONCLUSION: L'ostéomyélite chronique des membres est une pathologie fréquente en Afrique. Staphyloccocus aureus demeure le germe le plus fréquent. La chirurgie en un temps nous paraît une bonne alternative. Le taux de récidive de la suppuration reste élevé.
ABSTRACT
INTRODUCTION: Among the 1.4 million blind children in the world, 300,000 live in Africa. The causes of blindness vary from one country to another. The purpose of our study was to report the causes of childhood blindness and visual impairment in children attending the only school for the blind in Mali (National Institute for the Blind in Mali, INAM). MATERIALS AND METHODS: All children attending the INAM were examined. Blindness was defined as visual acuity less than 3/60 (20/400 or 0.05). Visual impairment was moderate when the visual acuity was less than 6/18 (20/70 or 0.30), but greater than or equal to 6/60 (20/200 or 0.1), and severe when visual acuity was less than 6/60 (20/200 or 0.1), but greater than or equal to 3/60 (20/400 or 0.05). RESULTS: The study included a total of 104 children. The average age of our patients was 12 years with a M/F sex-ratio of 1.12. In all, 85.6 % of the children were blind and 14.4 % visually impaired. The main causes of blindness were corneal opacities (26 %), and whole globe lesions and conditions (19.2 %). Ametropia accounted for 60 % of visual impairment. DISCUSSION: According to WHO, corneal and retinal damage are the leading cause of blindness (50.6 %) in children. In our series, corneal diseases were the leading cause, following by damage to the whole globe. CONCLUSION: The results of our study indicate that avoidable and treatable causes of childhood blindness are the leading causes of blindness of children at INAM.
Subject(s)
Blindness/etiology , Adolescent , Avitaminosis/complications , Cataract/congenital , Child , Child, Preschool , Corneal Diseases/complications , Female , Humans , Infant , Male , Mali , Measles/complications , Prospective Studies , Refractive Errors/complicationsSubject(s)
Melanoma/diagnosis , Optic Disk/pathology , Optic Nerve Neoplasms/diagnosis , Retinal Neovascularization/diagnosis , Adult , Fluorescein Angiography , Fundus Oculi , Humans , Male , Melanoma/complications , Melanoma/pathology , Optic Disk/diagnostic imaging , Optic Nerve Neoplasms/complications , Optic Nerve Neoplasms/pathology , Retinal Neovascularization/complications , Retinal Neovascularization/pathologyABSTRACT
A baby born at home 14 hours earlier was brought to the neonatology department with bilateral upper palpebral chemosis with purulent secretions and pseudomembranes, with no general signs of infection. The gram staining of a secretion sample shows the presence of Neisseria gonorrhoeae. Intramuscular ceftriaxone treatment was initiated, combined with topical application of rifamycin, dexamethasone, and oxytetracycline. Complete healing without sequelae was obtained after two weeks. This case presents an opportunity to review this preventable pathology and its treatment. The only effective way to prevent it is to raise the awareness of disadvantaged population about the value of antenatal care.
Subject(s)
Ophthalmia Neonatorum/drug therapy , Anti-Bacterial Agents/therapeutic use , Ceftriaxone/therapeutic use , Dexamethasone/therapeutic use , Female , Glucocorticoids/therapeutic use , Humans , Infant, Newborn , Oxytetracycline/therapeutic use , Rifamycins/therapeutic useABSTRACT
Esthetic and functional surgeries in the periocular region fall into the domain of oculoplastic, or plastic and reconstructive surgery and otorhinolaryngology. Oculoplasty is the largest surgical spectrum in ophthalmology including eyelids, orbits and the lacrimal system. Our purpose was to study the frequency of eyelid, lacrimal and orbital (oculoplastic) surgery at the CHU IOTA. MATERIAL AND METHODS: Retrospective medical chart review of all the patients who underwent oculoplastic surgery was conducted from October 2015 to September 2016. RESULTS: A total of 233 patients were included with 52% female and 48% male. Patients were 37 years old on average. In total, the surgery was performed on the eyelids in83 cases (35.6%), the orbits in 113 cases (48.5%) and the lachrymal system in 37 cases (15.9%).Eyelid surgery commonly resulted from eye trauma (43,3%), followed by malpositions (30,2%). Mutilating surgery accounted for 92% of the orbital surgery. External dacryocystorhinostomy was the main lacrimal surgery (42%) followed by canalicular lacerations 25%. CONCLUSION: Oculoplasticsurgeryoccupies an important place in the surgical activities of the ophthalmologic University hospital despite a larger volume for cataractsurgery. Our studydoesn't highlight the outcome of the surgery itself but the epidemiology to help decision makers in their eye health policy including the reduction of mutilating surgery and oculoplastic training.
La chirurgie esthétique et fonctionnelle de la région périoculaire est du domaine de l'oculoplastie, ainsi que de la chirurgie plastique et reconstructive et de l'otorhinolaryngologie. L'oculoplastie constitue le plus large éventail chirurgical en ophtalmologie regroupant la paupière, l'orbite et le système lacrymal. OBJECTIF: Etudier la fréquence des procédures chirurgicales orbito-palpébrales et lacrymales (oculoplasties) dans un centre de troisième référence. MATÉRIELS ET MÉTHODES: Il s'agissait d'une étude rétrospective des dossiers de patients opérés pour pathologies oculoplastiques d'octobre 2015 à septembre 2016. RÉSULTATS: Au total 233 patients ont été inclus dont 52% de sexe féminin et 48% de sexe masculin avec un âge moyen de 37 ans ; parmi lesquels 83 cas (35,6%) de chirurgie palpébrale, 113 cas (48,5%) de chirurgie orbitaire et 37 cas (15,9%) chirurgie lacrymale.La chirurgie palpébrale était dominée parréparationdesplaies traumatiques (43,3%), suivi des malpositions (30,2%). La chirurgie mutilante constituait 92% de la chirurgie orbitaire. La dacryocystorhinostomie par voie externe était la principale chirurgie lacrymale soit 42%, suivie des lacérations canaliculaires 25%. CONCLUSION: Notre étude ne met pas en exergue le résultat de la chirurgie elle-même, mais l'épidémiologie du traitement chirurgical afin d'aider les décideurs dans leur politique de santé oculaire notamment sur la réduction de la chirurgie mutilante et la formation oculoplastique.
ABSTRACT
But. Évaluer les connaissances et les attitudes dans une population rurale au Mali en ce qui concerne la cataracte. Patients et méthodes. Nous avons mené une étude transversale descriptive pendant une période de 10 jours au cours d'une campagne de soins ophtalmologiques dans la localité de Baguinéda, commune rurale située à 30 km de Bamako (Mali). Etaient inclus, les personnes âgées de 16 ans et plus. Les questions relatives aux connaissances et aux attitudes vis-à-vis de la cataracte leur étaient posées. Les connaissances et les attitudes devant une cataracte ont été corrélées aux paramètres comme l'âge, le sexe, la profession et le niveau d'instruction. Résultats. Au total, 552 personnes ont participé à l'étude. Leur âge moyen était de 46,1 ans ± 16,5 et le sex-ratio Homme/Femme de 1,38. Près de la moitié (45,65%) était sans emploi et la majorité (62,7%) analphabète. Dans 83,7 % de cas, les patients avaient des connaissances justes sur la cataracte. Vingt-quatre (4,3%) patients savent que le traitement est chirurgical et 242 (43,8%) pensent que le traitement est traditionnel. L'âge, le sexe et le niveau d'instruction étaient significativement liés à la connaissance de la cataracte. Conclusion. la connaissance de la cataracte dans la localité de Baguineda, en milieu rural au Mali est satisfaisante tandis que les attitudes sur sa prise en charge restent insatisfaisantes. Les stratégies de sensibilisation sont indispensables afin de réduire le taux de cécité au sein de ces populations défavorisées
Subject(s)
Cataract , Cataract/prevention & control , Mali , Patients , Rural PopulationABSTRACT
But : Les auteurs ont étudié les aspects épidémiologiques, cliniques, thérapeutiques et évolutifs des traumatismes oculaires reçus dans le service d'urgences ophtalmologiques au CHU-IOTA. Patients et méthodes : Il s'agissait d'une étude descriptive, rétrospective et longitudinale. Elle a concerné 148 patients admis à la garde pour traumatismes oculaires sur une période de 12 mois. Chaque patient a bénéficié d'un examen ophtalmologique aussi complet que son état et sa coopération le permettaient. Résultats : Parmi les 659 patients admis aux urgences, 148 traumatismes oculaires ont été recensés, soit une fréquence de 22,46%. Les hommes étaient les plus atteints, soit 68,24%. L'âge moyen des patients était de 17,34 ans et la tranche d'âge de 0 à 10 ans était prédominante. Les élèves et étudiants étaient les plus touchés par le traumatisme oculaire avec 31,08%. Les accidents de jeux (33,11%) ont constitué la principale circonstance du traumatisme oculaire. Parmi les agents traumatisants 22,97% étaient d'origine métallique. Les traumatismes oculaires à globe ouvert étaient prédominants à 58,78%. Malgré le recours à la chirurgie dans 63,51% des cas, l'évolution s'est soldée par une perte fonctionnelle du globe pour 21,62% des patients. Les complications et séquelles liées au traumatisme étaient notées respectivement dans 18,24% des cas et 26,35% des cas. Conclusion : Malgré la prise en charge en urgence, les traumatismes oculaires demeurent un problème de santé publique au Mali, de par leur fréquence, leur gravité et leurs séquelles pouvant évoluer vers la cécité. Ainsi, les actions de sensibilisation sur la prévention au niveau de la population sont indispensables afin de réduire leur fréquence
Subject(s)
Emergencies , Eye Injuries , Mali , PatientsABSTRACT
Depression plays an important role in clinical worsening, morbidity and mortality related to HIV/AIDS. To describe the epidemiological and clinical aspects of depressive disorders in people with HIV in Mali. This prospective study took place in the department of psychiatry and infectious diseases at the Bamako University Hospital from July 2004 through October, 2005 and included all HIV-positive antiretroviral-naive patients with depression, diagnosed according to ICD-10 criteria. The study included 84 HIV-positive patients with a depressive disorder; our total population of HIV-positive patients was 316 during the study period, for a prevalence rate of 26.7 % in this population. The mean age of these depressed patients was 36.7 ± 8.5 years (range: 20-57); 63.1% were women, 47.7% had not attended or at least not completed primary school; 66.6% were married, and 92.9% lived in urban areas. Sad mood, anxiety, and refusal to eat were reported by 27.7%, 10.9%, and 9.1%, respectively, as a reason for consultation. Depression was associated with an anxiety disorder in 33 (39.3%) and a delusional disorder in 14 (16.7%). Severe depression was associated with low BMI and at a CD4 count <200 cells/mm3. Depression was found at a high frequency in our study. Its detection, operational research about it, and improved management are recommended to improve the health of people living with HIV.
Subject(s)
Depression/diagnosis , HIV Infections/psychology , Adult , Anorexia/etiology , Anxiety/etiology , Asthenia/etiology , Depression/psychology , Female , Headache/etiology , Hospitals, University , Humans , Male , Mali/epidemiology , Middle Aged , Prevalence , Sleep Initiation and Maintenance Disorders/etiology , Young AdultABSTRACT
The aim of this work was to evaluate the public transport drivers' visual driving ability in Bamako. We carried out a descriptive cross-sectional study from May 15 to July 15, 2013. The probabilistic method was used. 385 drivers were examined at the University Hospital of the Institute of Tropical Ophthalmology of Africa (IOTA). The average age was 44.69 years. 296 drivers (76.9%) were able to drive public transport vehicles. Among drivers over 50 years old, 42.5% are unfit for driving. Color vision was normal in 98.7 % of cases. Ametropia, cataract and neuropathies accounted for 48.5%, 25.1% and 17.5% respectively, of the causes of impaired vision of drivers. According to European legislation, official transport drivers must be subject to periodic eye examinations. In the absence of such measures in Malian legislation, 42.5% of drivers over 50 years old are unfit to drive. The improvement of road safety requires the renewal and application of the texts for the delivery and renewal of the driver's license of public transport drivers.
Subject(s)
Automobile Driving/statistics & numerical data , Public Sector , Transportation , Vision Disorders/epidemiology , Accidents, Traffic/mortality , Accidents, Traffic/statistics & numerical data , Adult , Aged , Cross-Sectional Studies , Female , Humans , Male , Mali/epidemiology , Middle Aged , Vision Disorders/diagnosis , Vision Screening , Vision, Ocular/physiology , Workforce , Young AdultABSTRACT
INTRODUCTION: Treatment of cataract blindness is surgical to restore vision. The aim of this work was to compare the PKA to the classic EEC in the surgical treatment of adult cataract in terms of anatomical and functional results in our institute. MATERIALS AND METHODS: This was a cross-sectional study of 333 operated eyes of cataract of the adult and followed for one month. The postoperative functional data and the causes of poor results were specified. RESULT: A total of 172 men (51.7%) and 161 women (48.3%) underwent cataract surgery. The mean age was 64.2 years. 61.26% of patients had visual acuity (≥3 / 10) in EEC compared with 65.28% in PKA. (21%) for EEC, and (15%) for PKA had poor visual acuity (<1/10). The proportion of patients with good results increases with the best correction to 77.3% for EEC and 91.5% for PKA. The poor results close to those of the WHO in both techniques (6.7%). EEC and (5.3%) PKA. The poor results were mainly related to pre-existing pathologies (6.6%) and astigmatism related to surgery (7.1%). CONCLUSION: In order to achieve the objectives of "Vision 2020", within the framework of the fight against blindness, it is imperative to facilitate the popularization of the PKA throughout the African subregion.
INTRODUCTION: Le traitement de la cécité par cataracte est chirurgical permettant ainsi de restaurer la vision. Le but de ce travail était de comparer la phacomanuelle sans suture (PKA) à l'extraction extra capsulaire (EEC) classique dans le traitement chirurgical de la cataracte de l'adulte en terme de résultats anatomiques et fonctionnels dans notre institut. MATÉRIELS ET MÉTHODES: Il s'agissait d'une étude transversale sur 333 yeux opérés de cataracte de l'adulte et suivis pendant un mois. Les données fonctionnelles postopératoires et les causes de mauvais résultats ont été précisées. RÉSULTATS: Au total 172 hommes (51,7%) et 161 femmes (48,3%) ont subi une chirurgie de la cataracte. L'âge moyen était de 64,2 ans. L'acuité visuelle était bonne (≥3/10) chez (61,26 %) de nos patients en EEC contre (65,28%) en PKA. En EEC, (21%) et (15%) pour la PKA avaient une mauvaise acuité visuelle (<1/10). La proportion des patients avec de bons résultats augmente avec la meilleure correction à (77,3%) pour EEC et (91,5%) pour la PKA. Les mauvais résultats avoisinent ceux de l'OMS dans les deux techniques (6,7%) EEC et (5,3%) PKA. Les mauvais résultats étaient principalement liés aux pathologies préexistantes (6,6%) et astigmatismes liés à la chirurgie (7,1%). CONCLUSION: Pour atteindre les objectifs de la « vision 2020 ¼, dans le cadre de la lutte contre la cécité, il est impératif de faciliter la vulgarisation de la PKA dans toute la sous-région africaine.
ABSTRACT
INTRODUCTION: The treatment of cataract blindness is surgical, allowing restored vision. The purpose of this study was to evaluate the functional results of cataract surgery in adults in a tertiary care referral center. PATIENTS AND METHODS: Prospective study of 2012 eyes operated for adult cataract from September 1, 2009 to August 31, 2010 (12 months). The results were analyzed by the Monitoring Cataract Surgical Outcomes software (MCSO). The postoperative functional data and the causes of poor outcomes were identified. RESULTS: A total of 1044 women (51.9%) and 968 men (48.1%) underwent cataract surgery. Mean age was 65 years. Extracapsular cataract extraction (ECCE), and manual sutureless small incision cataract surgery (SICS) with posterior chamber IOL implantation in 98%, were the main surgical techniques. Functional results indicated that 45.5% of our patients had good visual acuity (≥3/10) with current spectacles, 33% had limited visual acuity (1/10-2/10), and 21.6% had poor visual acuity (<1/10). The proportion of patients with good results improved with best spectacle correction to 63%, vs. 22.9% with limited visual acuity and 14.1% with poor outcomes. The causes of poor outcomes were mainly related to surgical complications (42.1%) and refractive errors (34.8%). DISCUSSION: These results are inferior to WHO standards, which recommend a rate greater than or equal to 80% for good outcomes and a rate below 5% for bad outcomes. CONCLUSION: The identification of the causes of poor outcomes underscores the importance of improving surgical skills and the need for postoperative refraction.
Subject(s)
Cataract Extraction/methods , Cataract Extraction/rehabilitation , Adult , Aged , Aged, 80 and over , Clinical Competence , Female , Humans , Male , Middle Aged , Postoperative Period , Treatment Outcome , Visual AcuityABSTRACT
L'objectif etait d'apprecier les caracteristiques des cancers du pancreas exocrine et d'en analyser les resultats therapeutiques. Nous avons ainsi realise une etude retrospective dans le Service de Chirurgie generale du CHU Gabriel Toure de Janvier 1999 au 31 decembre 2008. Nous avons collige 43 cancers du pancreas soit 6;7des cancers digestifs. L'age moyen etait de 60 ans et le sex ratio de 1;69 au profit des hommes. Deux signes cliniques ont predomine : la douleur abdominale et l'ictere. Sur le plan evolutif; la presence d'une masse epigastrique palpable et l'amaigrissement ont ete notes. 22 malades (51;2) ontete vus au stade IV. 33 malades (76;7) ont ete operes et la derivation bilio-digestive a ete realisee chez 12 d'entre eux. L'examen microscopique de la piece operatoire a conclu a un adenocarcinome dans les 33 cas. La survie moyenne a ete de 18 mois apres chirurgie palliative et de 2;5 ans pres chirurgie curative
Subject(s)
Abdominal Pain , Disease Progression , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/therapyABSTRACT
INTRODUCTION: Exophthalmia is a rare entity. The purpose of this study was to ascertain epidemiological features, clinical aspects, and potential treatment modalities for exophthalmia in children at the University Teaching Hospital- African Institute of Tropical Ophthalmology (UTH-AITO). PATIENTS AND METHOD: This prospective and descriptive study was carried out from July 2006 to June 2007 at the IOTA-UTH in collaboration with the pediatric hematology and oncology unit of the Gabriel Toure UTH. All patients between the ages of 0 to 15 years who presented unilateral or bilateral exophthalmia whether measurable or not were included. In all cases thorough clinical workup was performed and any appropriate additional examinations were ordered. All data were consigned to a questionnaire. RESULTS: A total of 46 eyes in 38 children were included, i.e., unilateral right in 15 cases, unilateral left in 15 and bilateral in 8. Mean age was 9.6 years (range, 2 days to 15 years). The male-to-female sex ratio was 1.9:1. The incidence of exophthalmia was 0.3%. Exophthalmia was the reason for seeking medical advice in 68.4% of cases (26 children). Classification according to underlying pathology divided patients into four groups, i.e., inflammatory and/or infectious pathologies in 36.9% (14 cases), tumor pathologies in 31.6% (12 cases), trauma in 13.1% (5 cases) and undetermined in 18.4% (7 cases). A Hertel millimetric regression of exophthalmia was observed in 23.9% of cases (11 eyes) and a gain in visual lines of acuity was observed in 8.7% (4 eyes). DISCUSSION: Given the normally low frequency of exophthalmia, observation of a 0.3% incidence at a third level reference center warrants alerting of health authorities. Etiological classification was comparable to Crawford's as described by Desjardins. Cellulites (50%) and retinoblastoma (33.3%) were the main causes of exophthalmia. CONCLUSION: Since exophthalmia can cause loss of vision and even be life-threatening, early diagnosis and treatment is important particularly in children.
Subject(s)
Exophthalmos/epidemiology , Exophthalmos/etiology , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Mali/epidemiology , Prospective StudiesABSTRACT
Introduction. L'exophtalmie est un signe peu frequent. Determiner les aspects epidemiologiques; cliniques et les possibilites de prise en charge de l'exophtalmie de l'enfant au Centre hospitalier universitaire Institut d'Ophtalmologie Tropicale de l'Afrique (CHU-IOTA) etait l'objectif assigne a cette etude. Patients etmethode. Cette etude prospective et descriptive s'est deroulee de juillet 2006 a juin 2007 au CHU-IOTA; avec la collaboration de l'unite d'hematologie et d'oncologie pediatrique du CHU Gabriel Toure. Tous les patients ages de 0 a 15 ans qui presentaient une exophtalmie uni ou bilaterale; mesurable ou non etaient inclus.Un examen clinique complet etait realise et des examens complementaires appropries demandes. Toutes les informations etaient recueillies sur un questionnaire. Resultats. L'etude a retenu 46 yeux de 38 enfants : 15 OD; 15 OG et 8 bilateraux. L'age variait de 2 jours a 15 ans et sa moyenne etait de 9;6 ans. Le sex-ratio etait de 1;9 garcons pour 1 fille. La frequence de l'exophtalmie retrouvee etait de 0;3. L'exophtalmie constituait le motif de consultation dans 68;4des cas; soit 26 enfants. Notre classification des groupes etiologiques etait faite de 36;9de pathologies inflammatoires et/ou infectieuses (14 cas); de 31;6de pathologies tumorales (12 cas); de 13;1de traumatismes (5 cas); et de 18;4de causes indeterminees (7 cas). L'exophtalmie avait subi une regression millimetrique au Hertel dans 23;9des cas soit 11 yeux; pendant que 4 yeux malades avaient gagnes des lignes d'acuite visuelle; soit 8;7. Discussion. La frequence de 0;3de l'exophtalmie dans un centre de troisieme reference est suffisante pour alerter les autorites sanitaires quand on sait que cette pathologie est peu frequente. La classification est comparable a celle de Crawford evoquee par Desjardins. Les cellulites (50) et les retinoblastomes (33;3) etaient les deux etiologies les plus frequentes de l'exophtalmie. Conclusion. L'exophtalmie est un risque de perte de la fonction visuelle et meme vitale qu'il faut savoir prendre en charge a temps chez l'enfant
Subject(s)
Child , Disease Management , Exophthalmos/diagnosis , Exophthalmos/epidemiologySubject(s)
Orbital Cellulitis , Sinusitis , Child , Female , Humans , Male , Middle Aged , Orbital Cellulitis/therapy , Sinusitis/therapyABSTRACT
Les auteurs rapportent deux cas de cellulites periorbitaires colligees sur une annee dans le service ORL. Ces deux cas ont la particularite d'etre survenue chez des enfants dans un contexte de pyorrhee alveolodentaire et de poly sinusites faciales associees. Le parcours therapeutique avant l'hopital a ete emaille de traitement traditionnel dans un cas et d'automedication dans l'autre. Dans les deux cas le medecin referent a ete un ophtalmologiste. Les deux patients ont ete admis en hospitalisation ORL au stade de phlegmon periorbitaire collecte ayant necessite un drainage chirurgical sous anesthesie generale. Les suites operatoires ont ete simples; cependant un des enfants admis au stade d'une acuite visuelle reduite a la simple perception lumineuse n'a pas recupere de sa perte de vision
Subject(s)
Blindness , Case Reports , Dental Caries , Orbital Cellulitis , Sinusitis/complicationsABSTRACT
The discovery of unilateral exophthalmia requires multidisciplinary care made all the more difficult in the case of a 14-year-old girl living in a tropical environment. The child, C.A., resident of the town of Djenné in Mali, was examined for nonpulsate, nonretractile, left lateral unilateral exophthalmia, painful upon palpation of a left upper-external mass under the orbital rim. The initial examination highlighted the existence of an intraorbital tumor with a moderate effect on visual function. In view of the slow and progressive development over 2 years, and with the assistance of an association, the child was transferred to a specialized medical structure where the tumorous nature was confirmed after surgical exeresis. The diagnosis was cylindroma, or adenoid cystic carcinoma. Neither chemotherapy nor radiation were used. At 15 months after surgery, the child showed no clinical sign of recurrence. Intraorbital tumors in children present diagnostic and therapeutic problems in countries with limited medical resources. Cylindromas or adenoid cystic carcinomas of the lachrymal gland are the second most common cause of epithelial tumors in this gland, which are characterized by a high degree of malignancy, a very high rate of recurrence, and a low survival rate at 5 years. In a tropical environment, diagnostic and therapeutic difficulties are compounded by limits to comprehensive care for the child.