RESUMEN
To describe the process of establishing a reference center for gestational trophoblastic diseases (GTD) in Senegal and to report its main results so far. We describe the history and establishment of the center, which is based on the experience of the main international centers. The adaptations made to patient follow-up are detailed, while we follow FIGO and WHO diagnostic and management criteria. Finally, we report our main results. Between 2011 and 2017, 878 files were registered at the Center. More than half of the women had no histological confirmation of GTD (60.8 %). The diagnosis was then based on ultrasound images or macroscopic examination of molar vesicles. Spontaneous remission occurred in 64.5 % of the cases, while gestational trophoblastic neoplasia developed in 23.5 %. The FIGO criteria were slightly adapted for hCG monitoring. Methotrexate was the drug of choice in the low-risk group (97.8 %), while the EMACO protocol was financially difficult for nearly half of the high-risk group. The overall remission rate was 83 % and the specific lethality 11.6 %. Our center has demonstrated the efficiency of centralizing the management of GTDs. Difficulty in access to hCG and antimitotic drugs makes management difficult. However, we have introduced alternative solutions that we are working to improve.
Asunto(s)
Enfermedad Trofoblástica Gestacional , Adolescente , Adulto , Femenino , Enfermedad Trofoblástica Gestacional/diagnóstico , Enfermedad Trofoblástica Gestacional/terapia , Administración de Instituciones de Salud , Recursos en Salud , Humanos , Persona de Mediana Edad , Embarazo , Senegal , Adulto JovenRESUMEN
To describe a new training approach for emergency obstetric and neonatal care (EmONC) introduced in Senegal to strengthen the skills of healthcare providers. The approach was based on skills training according to the so-called "humanist" method and on "lifesaving skills". Simulated practice took place in the classroom through 13 clinical stations summarizing the clinical skills needed for EmONC. Evaluation took place in all phases, and the results were recorded in a database to document the progress of each learner. This approach was used to train 432 providers in 10 months and to document the increase in each participants' technical achievements. The combination of training with the "learning by doing" model ensured that providers learned and mastered all EmONC skills and reduced the missed learning opportunities observed in former EmONC training sessions. Assessing the impact of training on EmONC indicators and introducing this learning modality in basic training are the two major challenges we currently face.
Asunto(s)
Neonatología/educación , Obstetricia/educación , Complicaciones del Embarazo/terapia , Entrenamiento Simulado , Competencia Clínica , Evaluación Educacional , Urgencias Médicas , Femenino , Humanos , Embarazo , SenegalRESUMEN
To describe the profile of Senegalese black women with breast cancer. This is a retrospective and prospective study of patients receiving care for breast cancer in the breast diseases department of the Aristide Le Dantec Teaching Hospital in Dakar from 2010 through June 2014. 188 women patients met the inclusion criteria. Their mean age at diagnosis was 43.3 years. The age of onset of the first menses was early (<12 years) in 7 patients (4.9%). More than two thirds of the women (71.6%) were premenopausal at diagnosis. At least one pregnancy was reported by 161 women (86.1%) and 96.3 had given birth. Mean age at first pregnancy was 19.47 years, and 85.9% had had their first pregnancy before the age of 30. Similarly, 133 (87.3%) had breastfed, for a mean duration of 18.36 months. In our country, breast cancer occurs in young women, who had their first menses after 12 years, are premenopausal, had their first pregnancy before the age of 30, and breastfed for several months. These data suggest that further study of this profile is needed but that the testing policy must change drastically, to start much earlier than 50 years.
Asunto(s)
Población Negra , Neoplasias de la Mama/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , Factores de Riesgo , Senegal/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: To report the experience of our unit with vaginal cesarean deliveries. PATIENTS AND METHODS: This is a retrospective, descriptive study of seven vaginal cesarean deliveries performed in the maternity unit of the Centre Hospitalier Regional Universitaire de Saint-Louis in Senegal during the third quarter of 2012. The women's clinical characteristics were studied and indications for cesarean sections discussed. RESULTS: The seven vaginal cesareans accounted for 3.2% of the cesarean deliveries performed during the study period (219) and 0.6% of all births (1428). The women's average age was 31 years. Gestational age ranged from 17 to 34 weeks of gestation. The principal indication for surgery was placental abruption, in 5 (72%) cases). The fetus was dead in 4 of the 7 cases. The mean 5-min Apgar score at birth for the liveborn infants was 5 (of an optimum score of 10). Mean fetal weight at birth was 1700 g. The mean operative time was 20.7 minutes. In one case, the incision extended to the uterine corpus. The postoperative course was uneventful in all cases. CONCLUSION: Vaginal cesarean is safe, fast, but not without complications. It requires perfect mastery of vaginal surgery.
Asunto(s)
Cesárea/métodos , Adulto , Femenino , Humanos , Embarazo , Estudios Retrospectivos , Senegal , Vagina , Adulto JovenRESUMEN
The aim of this study was to determine the clinical features and outcomes of women younger than 35 years with breast cancer. This study was performed at Gynecologic and Obstetric Clinic of Dakar Teaching Hospital and retrospectively reviewed the records of all women younger than 35 years seen in our department for histologically proven breast cancer. Data were analyzed with SPSS software (Statistical Package for Social Science) Version 23. Between 2007 and 2015, 62 women with breast cancer met the inclusion criteria and were included. The incidence of women in this age group treated in our department was 22.6%. The median age at diagnosis was 29.7 years. The mean time to consultation was 12.5 months, and the disease was locally advanced at diagnosis in 79% of cases. Histological study found 85.5% of cancers were invasive ductal carcinoma. The immunohistochemical study found positive hormone receptors in 12 women (19.4%) and overexpression of HER-2 in 8 (12.9%). Chemotherapy was performed in 54 patients (87.1%), and surgery in 47 (62.9%). Recurrence occurred in 12. In all, 22 women died (35.5%) by the end of the study period. Mean survival was 36.7 months (CI 29.5 to 43.9) and median survival 39.7 months (CI 22.1 to 57.5). This high incidence rate in our study is consistent with that found in young African-American women and is worrisome. These results seem to point towards a genetic origin and call for a thorough search of the profile. They also call also for the involvement of pathologists and collaboration with other research teams.
Asunto(s)
Neoplasias de la Mama/epidemiología , Adulto , Factores de Edad , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/terapia , Femenino , Hospitales de Enseñanza , Humanos , Estudios Retrospectivos , Senegal/epidemiología , Resultado del TratamientoRESUMEN
OBJECTIVES: Specify epidemioclinical and legal aspects of sexual abuse among minors and evaluate the cost of care in Dakar. MATERIALS AND METHODS: This is a retrospective multicenter cross-sectional study on sexual abuse among minors over a period of four years from 1st January 2006 to 31st December 2009. Four maternities were targeted: the Social Hygiene Institute of Medina, health center Roi-Baudouin Guédiawaye, the Pikine hospital and health center Youssou-Mbargane-Diop of Rufisque. RESULTS: During the study period, 252 child victims of sexual abuse were supported at four health facilities on a total of 272 sexual abuses of all ages, a frequency of 92.64%. The epidemiological profile of our patients was a child of 11 years old on average, female (100%) and living in the suburbs of Dakar (68.1%). Children were often abused during working hours (31.7%), outside the family environment and often by someone known to the victim (72.6%). Genito-genital contact was the most common mode of sexual contact (80.9%) with vaginal penetration in 61% of cases. Almost all of the victims (92.1%) came to consult, accompanied by their parents, between the 1st and 4th day after the sexual abuse (70%). The examination usually revealed a hymenal trauma (59.9%) of which nearly half (49%) consisted of old lesions. 56.9% of victims had a post-traumatic stress disorder and 31.1%, mutism. We recorded six (6) pregnancies, 2% of our sample. A case of HIV infection was recorded on a sample taken 72hours after sexual abuse. Control of three months HIV serology was requested in 7.1% of cases and only 20% of children had received antiretroviral prophylaxis. Antibiotic prophylaxis had been performed in 13.7% of cases using doxycycline as drug of choice (75%). Only 29% of our patients had received emergency contraception progestin and psychological care concerned only 22% of children. On the legal aspects, 46% of our patients had filed a complaint. Prosecutions were 38%, 45% of which were convicted and 21% were acquitted. The rate of out-of-court settlement was 35% and the time limit for settlement by the justice was on average 6 months with extremes of one month and 24 months. The average cost of care was estimated at 17,010 CFA francs (26 euros) taking into account the consumables used for clinical examination (sterile gloves, catheter, syringe), analysis and prescription drugs. CONCLUSION: The sexual abuse of minors is a disturbing reality that raises rightly universal reprobation. In Senegal, this mainly affects children and its magnitude is increasing over the years. Improved support for victims necessarily involves raising public awareness through the media and the development of specialized structures in the management of sexual abuse.
Asunto(s)
Abuso Sexual Infantil/legislación & jurisprudencia , Abuso Sexual Infantil/estadística & datos numéricos , Adolescente , Niño , Abuso Sexual Infantil/economía , Preescolar , Costos y Análisis de Costo , Estudios Transversales , Femenino , Humanos , Masculino , Estudios Retrospectivos , SenegalRESUMEN
Rangeland-based livestock systems have to deal with the significant instability and uncertainty of the agricultural context (policy changes, volatility of input prices, etc.), and especially of the climatic context. Thus, they are particularly concerned by adaptive management strategies. To support the development of such strategies, we developed a board game including a computer model called "Rangeland Rummy". It is to be used by groups of farmers and agricultural consultants in the context of short workshops (about 3 h). Rangeland Rummy builds upon five types of material object: (i) a game board; (ii) a calendar stick indicating the starting date of the game board; (iii) sticks marked with the feed resources available for combinations of vegetation types and their management practices; (iv) cards to define animal groups and their feeding requirements throughout the year; (v) cards related to types of feed that can be attributed to animal groups throughout the year. Using these material objects, farmers collectively design a rangeland-based livestock system. This system is immediately evaluated using a computer model, i.e. a spreadsheet providing graphs and indicators providing information on, among other things, the extent to which quantitative and qualitative animal feeding requirements are covered across the year. Playing the game thus consists in collectively and iteratively designing and evaluating rangeland-based livestock systems, while confronting the players with new contextual challenges (e.g. interannual variability of weather, volatility of input prices) or new farmers' objectives (e.g. being self-sufficient for animal feeding). An example of application of Rangeland Rummy with 3 farmers in southern France is reported. Applications show that it tends to develop farmers' adaptive capacity by stimulating their discussions and the exchange of locally-relevant knowledge on management strategies and practices in rangeland-based livestock systems.
Asunto(s)
Agricultura/economía , Agricultura/organización & administración , Juegos Experimentales , Ganado/crecimiento & desarrollo , Animales , Educación , Francia , HumanosRESUMEN
Objectifs : Decrire les difficultes rencontrees par les parturientes evacuees dans une zone rurale au Senegal. Methodologie : Etude prospective sur une periode de 12 mois allant de janvier a decembre 2011. Toutes les patientes evacuees vers la maternite. Resultats :La frequence des evacuations obstetricales etait de 31;2. Le nombre moyen de consultation prenatale etait de deux. Une femme sur 3 avait effectue plus de 4CPN (33;3). La grossesse etait a terme dans 83;6 des cas. La distance parcourue etait en moyenne de 48 Km avec des extremes de 1 a 200 km. L'evacuation etait faite au moyen d'une ambulance dans 69 des cas et celle-ci etait accompagnee par un prestataire non qualifie dans 92;7 des cas. La patiente etait vivante bien portante dans 98 des cas. L'enfant etait ne vivant bien portant dans 75;4. La duree de sejour moyenne etait de 2;6 jours avec des extremes de 1 et 12 jours. La contre-reference etait effectuee dans 97;3 des cas. Conclusion : Les resultats de notre etude nous permettent de confirmer malgre les ressources limitees; il est possible de prendre en charge et de reduire la morbidite et la mortalite des patientes evacuees. En effet nous preconisons de mettre en place un systeme de SAMU obstetrical en zone rurale afin de contribuer a la regulation des evacuations obstetricales; mais surtout de permettre aux patientes a faible revenu d'acceder au service
Asunto(s)
Mortalidad Materna , Pase de Guardia , Hemorragia Posparto , Población RuralRESUMEN
OBJECTIVES: To assess the quality of prenatal monitoring of pregnant women with a previous cesarean delivery and determine the maternal and neonatal prognosis in an African setting. PATIENTS AND METHODS: This prospective, descriptive, and analytical study took place at Roi Baudouin Health Center in Dakar (Senegal) and examined the records of women giving birth from November 1, 2009 to August 31, 2010. It included all women admitted for delivery at 22 weeks of gestation or more, with at least one previous cesarean, and a prenatal consultation record booklet. Women with uterine scars from a gynecological intervention were excluded. The study included a qualitative analysis of the record booklets and an interview of patients. RESULTS: Women with previous cesareans accounted for 12.5% of all women giving birth during the study period. The average age of the women in our study was 28 years, their mean parity was 3, and their mean number of prenatal examinations 3 (range: 1 to 5). Most prenatal care was provided by midwives (95.1%). The clinical characteristics were rarely completed. Not all women had undergone the laboratory tests required, and fewer than half (40.7%) had had a third-trimester ultrasound. In all, 109 (28.1%) had been referred to the hospital as an appropriate structure for their delivery. Complications of labor were observed in 28.3% of the cases. In 73% of these cases, women had repeat cesareans; 26% had vaginal deliveries. The performance of the recommended prenatal check-up was significantly correlated to how early prenatal care began (p = 0.001) and the level of the structure providing prenatal care (p = 0.027). CONCLUSION: Reducing maternal and fetal morbidity and mortality due to uterine scars requires that women be made aware of the relevant issues and that healthcare providers refer them appropriately and early.
Asunto(s)
Cesárea , Atención Prenatal , Adolescente , Adulto , Femenino , Humanos , Embarazo , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Adulto JovenRESUMEN
OBJECTIVE: To determine the risk of recurrent trophoblastic disease after normalisation of human chorionic gonadotrophin (hCG) levels in women with hydatidiform mole. DESIGN: A retrospective review of data from a national gestational trophoblastic disease centre. SETTING: The Trophoblastic Disease Unit, Dakar, Senegal. SAMPLE: Women with pregnancies affected by hydatidiform mole registered between 2006 and 2012. METHODS: The women were followed up in accordance with the hospital protocol 'Score de Dakar'. For women who progressed to gestational trophoblastic neoplasia (GTN) the time to onset of GTN, treatment and evolution were evaluated. The rate of evolution to GTN after normalisation of hCG was determined. MAIN OUTCOME MEASURES: Rate of occurrence of GTN after chemotherapy for hydatidiform mole. RESULTS: Five hundred and thirty-one women were diagnosed to have molar pregnancies. According to the hospital's protocol, 107 (20.2%) of these had chemotherapy and 224 (42.2%) had prophylactic chemotherapy. Five hundred and thirteen women (96.4%; 95% confidence interval [95% CI] 95.05-98.14%) achieved remission. Eighteen women (3.4%; 95% CI 1.86-4.94%) developed GTN (11 before remission and seven after remission). Seven women out of the 18 developed GTN after hCG normalisation (1.3%). Five of these seven were diagnosed beyond the recommended period of follow up. The mean interval to diagnosis of GTN was 18.7 months. These seven women underwent combination chemotherapy: five achieved complete remission whereas two died from GTN. CONCLUSIONS: Cytotoxic therapy for hydatidiform mole does not prevent GTN, it delays its diagnosis and promotes GTN after normalisation of hCG.
Asunto(s)
Antineoplásicos/uso terapéutico , Gonadotropina Coriónica/sangre , Enfermedad Trofoblástica Gestacional/patología , Neoplasias Uterinas/patología , Adulto , Femenino , Enfermedad Trofoblástica Gestacional/sangre , Enfermedad Trofoblástica Gestacional/tratamiento farmacológico , Enfermedad Trofoblástica Gestacional/epidemiología , Humanos , Recurrencia Local de Neoplasia/prevención & control , Embarazo , Estudios Retrospectivos , Senegal/epidemiología , Resultado del Tratamiento , Neoplasias Uterinas/sangre , Neoplasias Uterinas/tratamiento farmacológico , Neoplasias Uterinas/epidemiologíaRESUMEN
We report the surgical management of eight vulvar tumors occurred at the waning of female genital mutilation practiced in childhood. Patients were aged 19 to 38 years. It was essentially excision type 2. Surgical excision of the labia minora with a refund without clitoral plasty gave satisfactory aesthetic and functional results. Histological examination of these tumors showed a single cyst containing keratin without inflammatory reaction.
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Circuncisión Femenina/efectos adversos , Clítoris/cirugía , Quistes/etiología , Quistes/cirugía , Enfermedades de la Vulva/etiología , Enfermedades de la Vulva/cirugía , Adulto , Quistes/patología , Femenino , Humanos , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Despite the frequency of hysterectomy, several studies have reported physical and psychological sequelae of this intervention. BUT: To evaluate the consequences of hysterectomy, their level of importance and how patients experience hysterectomy. METHODS: That is a prospective study of 70 patients who underwent a hysterectomy from January 2009 to June 2011 at Pikine National Hospital. The experience of hysterectomy was determined by the physical and psychosocial felt after surgery. RESULTS: Hysterectomy represented 5.9 % of gynecological surgical activities. The indications were dominated by myoma (57.1%). Hysterectomy was performed abdominally in 78.6% of cases and associated with bilateral salpingo-oophorectomy in 87% of cases. After surgery, new symptoms appeared: hot flushes, night sweats, urinary incontinence and urge incontinence in respectively 65.7%, 54.3%, 7.1% and 11.4% of patients. A proportion of 45.6% of them had resumed sexual activity after 90 days. The fear of pain at the time of intercourse was expressed in 55.7% of cases. A decrease in the frequency of sexual intercourse was found in 54.3% of patients. A drop of pleasure during sex was expressed in 38.6% of patients. Psychological effects were also reported by patients: decreased confidence in 31.4% of patients, feeling of being rejected by her husband in 5.7% of cases, sensation of mutilation in 24.3% of cases. CONCLUSION: Physical and psychological postoperative impacts of hysterectomy are real. Adequate accompanying measures are necessary, in addition to preoperative preparation, to allow patients to improve the experience of hysterectomy.
Asunto(s)
Histerectomía/efectos adversos , Adulto , Femenino , Hospitales Públicos , Sofocos/epidemiología , Sofocos/etiología , Humanos , Hiperhidrosis/epidemiología , Hiperhidrosis/etiología , Histerectomía/psicología , Persona de Mediana Edad , Satisfacción del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Senegal/epidemiología , Disfunciones Sexuales Psicológicas/epidemiología , Disfunciones Sexuales Psicológicas/etiología , Incontinencia Urinaria/epidemiología , Incontinencia Urinaria/etiología , Adulto JovenRESUMEN
OBJECTIVES: To demonstrate the feasibility of copper IUD insertion following cesarean deliveries and assess its safety. PATIENTS AND METHODS: This is a prospective pilot study at Pikine national hospital from February 15 to November 15, 2012. Were evaluated the efficacy, incidence and spectrum of complications and continuation rates. RESULTS: Fifty-nine subjects were enrolled and 46 received an IUD. The average age of patients was 28 years. No patient had previously used IUDs. Forty-four patients (97.5%) were returned to the first follow-up visit at the first month, 41 patients (89.1%) at the second visit and 39 patients (86.9%) at the third visit. The rate of lost sight was 8.7%. Pain and bleeding were reported rarely: 2.3% at the first month, 4.9% at the third month and 7.7% at the sixth month for the bleeding and 6.8% at the first month, 2.4% at the third month and 2% at the sixth month for pain. The rate of expulsion was 2.2%. CONCLUSION: The insertion of the IUD following cesarean delivery has an acceptable rate of expulsion and no increased rate of adverse effects. This technique should be popularized.
Asunto(s)
Cesárea , Dispositivos Intrauterinos de Cobre , Adolescente , Adulto , Femenino , Hospitales de Enseñanza , Humanos , Expulsión de Dispositivo Intrauterino , Dispositivos Intrauterinos de Cobre/efectos adversos , Metrorragia/epidemiología , Persona de Mediana Edad , Dolor , Proyectos Piloto , Periodo Posparto , Embarazo , Estudios Prospectivos , SenegalRESUMEN
UNLABELLED: The aims of this work are to study the nursery futures during idiopathic myocardiopathy of peripartum (IMPP), to measure the prevalence of thromboses and spontaneous contrast during the IMPP and to determine their evolution. METHODOLOGY: It is about a longitudinal exploratory study carried out with the Aristide-Le-Dantec teaching hospital of Dakar, beginning January 2001 to November 2004, having included 33 patients. RESULTS: The average age of the patients was 26 years; the average pregnancy was of 3.39 gestures. The signs of cardiac insufficiency were constant and four patients (12%) had presented an ischemic cerebral vascular accident. We had raised an auricular case of fibrillation and tachycardia atrial multifocal. The transthoracic echography (ETT) noted an aspect of hypokinetic myocardiopathy dilated with deterioration of the systolic function of the left ventricle, a thrombus in ten patients (30.3%) and a spontaneous contrast in two cases (6%). The transoesophageal echocardiography (ETO) was superposable with the ETT with regard to dimensions of the cardiac cavities and the presence of thrombus but its sensitivity was higher (100% against 66%) with regard to the detection of contrasts spontaneous. All the patients had the treatment of a congestive heart failure associated to an anticoagulant treatment. The evolution was marked by an improvement of the heart failure. The thrombus and spontaneous contrast had disappeared in all the patients. The absence of anaemia and the presence of spontaneous contrast (p=0.003) were correlated with the presence of thrombosis (p=0.05). CONCLUSION: The idiopathic myocardiopathy of the peripartum is a relatively frequent affection in zone Soudano-Sahelian. Occurrence of thromboses is frequent at the time of this affection. Our study confirms the superiority of the echocardiography transoesophageal in the detection of intracardiac spontaneous contrast. The evolution can be favourable subject to a rigorous care and a regular surveillance.
Asunto(s)
Cardiomiopatía Dilatada/complicaciones , Ecocardiografía Transesofágica , Periodo Periparto , Tromboembolia/epidemiología , Tromboembolia/etiología , Adulto , Anticoagulantes/uso terapéutico , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/epidemiología , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/epidemiología , Cardiomiopatía Dilatada/diagnóstico por imagen , Cardiomiopatía Dilatada/tratamiento farmacológico , Femenino , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/epidemiología , Hospitales Universitarios , Humanos , Estudios Longitudinales , Proyectos Piloto , Embarazo , Prevalencia , Estudios Prospectivos , Senegal/epidemiología , Taquicardia/diagnóstico por imagen , Taquicardia/epidemiología , Tromboembolia/diagnóstico por imagen , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/epidemiologíaRESUMEN
In front of the absence of a mammographic screening program and the late diagnosis of the breast cancers in Senegal, we wanted to evaluate the knowledge and the practice of the breast self examination (BSE) by feminine population in Senegal. During the period between July 10th to August 25th 2006, through five big hospitals in Dakar, we interviewed 300 patients coming from a medical or surgical consultation. For every patient we studied the social and demographic characteristics, the antecedents and arguments about the knowledge and practice of BSE. We found, in majority, a young population (the average age was 34 years), no sent to school (26.7%), without any financial income (58.7%), with a brief knowledge about BSE (42.7%) and a regular practice of BSE (29%). The information about BSE originated essentially from educational television (52.9%). This knowledge and practice were significantly influenced by the study level (p = 0.000) and the level of financial income (p = 0.02). Among these who presented certain factors of breast cancer risk, the knowledge and the practice of the BSE were however low. The authors insist on the need to encourage the women schooling and their socioprofessional insertion so to improve the knowledge and practice of the breast self-examination in our developing countries.
Asunto(s)
Neoplasias de la Mama/epidemiología , Autoexamen de Mamas/métodos , Adulto , Países en Desarrollo/estadística & datos numéricos , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Renta , Educación del Paciente como Asunto , Senegal/epidemiologíaRESUMEN
OBJECTIVE: The persistence of the rheumatic valvular cardiopathie and the access to cardiac surgery make this association frequent. This work will deal with a description of the epidemiological and clinic profile and the evaluation of the cares to the pregnancies with cardiac valvular prostheses. METHODOLOGY: We took a retrospective study beginning from 1987 to 2006 about 14 cases, which had benefited from collaboration between the Gynaecologic and Obstetric Clinic and the Cardiological Clinic of the University Hospital Center of Dakar. RESULTS: The frequency of pregnancies with valvular prosthesis was of 0.12 per thousand. The average age of our patients was of 27.7 years. The average pregnancy was of 2.3 gestures with extremes of 1st to 12th gestures. The pregnancies were not, in any case, planned. An auricular fibrillation was noticed in four patients. The fraction of ejection of the left ventricle was superior or equal to 60% in 10 cases, the prosthesis was lightly blocked in two cases. Despite the use of anti-vitamin K during the first trimester with 42.86% of the patients, the anticoagulation was effective with the entire cases excepted one who died by lung embolism. The delivery was, in seven cases, realized by caesarean and in two cases by natural way. Two cases of premature and foetal hypotrophy have been noticed. There was no case of malformed children. CONCLUSION: With a multidisciplinary care, the carry of valvular prosthesis can be compatible with pregnancy. The lack of embryopathy and malformed children could incite to propose the oral anticoagulation during the whole sequence of pregnancy.
Asunto(s)
Prótesis Valvulares Cardíacas/efectos adversos , Complicaciones Cardiovasculares del Embarazo/epidemiología , Resultado del Embarazo , Embarazo de Alto Riesgo , Adulto , Anticoagulantes/efectos adversos , Anticoagulantes/uso terapéutico , Femenino , Enfermedades de las Válvulas Cardíacas/cirugía , Humanos , Recién Nacido , Válvula Mitral/cirugía , Embarazo , Complicaciones Cardiovasculares del Embarazo/mortalidad , Índice de Embarazo , Pronóstico , Falla de Prótesis , Estudios Retrospectivos , Factores de Riesgo , Senegal/epidemiología , Tasa de Supervivencia , Trombosis/etiología , Trombosis/prevención & control , Válvula Tricúspide/cirugíaRESUMEN
Hormonal contraception is based on the use of synthetic hormones containing variable doses of oestrogen and progesterone making it possible to avoid pregnancy in a temporary and reversible way. The objective of this study is to evaluate the periodontal status of a sample of Senegalese women under hormonal contraceptive. One hundred women using contraception since at least 6 month were paired on the age, the socio-economic profile and oral hygiene with a control group. Oral hygiene (plaque index (PI) of Silness and Löe), the inflammation (gingival index (GI) of Löe and Silness), probing depth and clinical attachment loss were recorded. With equal hygiene, the scores of the gingival index were significantly higher among women under contraceptive (p < 0.001). Inflammation was significantly more marked for the women who used contraception in injectable form compared to the control group (p < 0.001). Probing depth (3.01 +/- 0.04) and clinical attachment loss (3.19 +/- 0.08) were significantly more important among women under contraceptive (p < 0.001). The women under contraceptive seem to set up a group at risk for developing a periodontal disease, it is thus necessary to systematise periodontal appraisal before and during contraceptive use period.
Asunto(s)
Anticonceptivos Hormonales Orales/efectos adversos , Gingivitis/inducido químicamente , Levonorgestrel/efectos adversos , Acetato de Medroxiprogesterona/efectos adversos , Periodontitis/inducido químicamente , Adolescente , Adulto , Estudios de Casos y Controles , Índice de Placa Dental , Femenino , Humanos , Persona de Mediana Edad , Índice PeriodontalRESUMEN
OBJECTIVES: To carry out the epidemiological and clinical characteristics of supposed victims of sexual abuse and to evaluate case management. PATIENTS AND METHODS: A prospective study was conducted about cases of presumed sexual abuse received at the gynaecological and obstetrical clinic department of Aristide-le-Dantec hospital from January 2003 to May 2005. RESULTS: A total of 55 cases were reported and represented 0.4% of admissions in the clinic during the period of study. Twenty percent of them (20%) were referred on judicial requisition. The mean time between sexual abuse and consultation was 15 days. Victims were 14 years old in average, nulligeste in 96.5% of cases and living in the suburban area of Dakar. The presumed "violenter" was a man of 32 years, belonging to the environment of the victim in 70% of cases (spiritual guide, joint-tenant, friend of the family...). The type of sexual assault was an unprotected genito-genital intercourse in 67.3% of cases. On the clinical plan, 70.9% of patients suffered recent genital traumatism, 54.5% genital examination showed hymeneal lesions. The HIV test was positive in two cases. During the follow-up of the patients, three pregnancies occurred and for only 9.1%, a psychological assistance was proposed. CONCLUSION: Sexual abuses represent a current sociocultural issue. Prevention required large information campaign. Early management is necessary in order to prevent the sexual transmitted diseases and psychological side effects.
Asunto(s)
Víctimas de Crimen/estadística & datos numéricos , Delitos Sexuales/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Niño , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Hospitales Universitarios , Humanos , Persona de Mediana Edad , Embarazo , Índice de Embarazo , Estudios Prospectivos , Senegal/epidemiología , Vagina/lesionesRESUMEN
OBJECTIVES: Establish specificity, sensibility of clinical pelvimetry using X-ray pelvimetry as the reference exam; Assess reproducibility of clinical pelvimetry comparing two physicians' findings. PATIENTS AND METHODS: During a longitudinal study of 29 months, we compared clinical clinical pelvimetry findings of 114 patients with results of X-ray pelvimetry. Reproducibility was assessed comparing pelvic measures performed by two physicians for 40 patients. Based on caesarean ratio of 7% due to cephalopelvic disproportion in our department, the required size of sample was estimated between 114 and 200 patients. Statistics tests used were the independent test of Chi-2, the Kappa coefficient, the T-test and discriminant analyze. A p-value of 0.05 was considered as significant. RESULTS: The sensibility of clinical pelvimetry was found at 83.7%, specificity at 88.9%. Positive predictive value was 97.6% and negative predictive value founded at 50%. Best concordances were obtained for the measures of vertical diameter of Michaelis, Trillat diameter and assessment of sciatic spines and inominated lines. Clinical pelvimetry was reproducible with a kappa value of 0.62. CONCLUSION: Clinical pelvimetry, due to his good specificity and satisfactory reproducibility is still relevant in case of unavailability of X-ray pelvimetry as it happens in Africans ressourceless countries.