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The practice of excision in girls poses a significant risk to their health. The objective of this study was to determine the immediate acute complications associated with this practice. PATIENTS AND METHODS: This was a retrospective descriptive study over a period of 15 months including all girls aged 0-15 years hospitalized for acute complications related to excision within 7 days of the practice in the pediatric department of the University Hospital Gabriel Toure. RESULTS: We collected 17 patient files. The median consultation time was 43 h. The main reason for consultation was post-excision bleeding in 76.4% of the cases. Pallor associated with respiratory distress was found in almost all cases. On admission, four girls (23.5%) were comatose and five girls (29.4%) showed signs of shock. The reasons for hospitalization were hemorrhage associated with post-excisional sepsis (52.9%), complicated shock anemia (23.5%), and severe post-excision anemia (23.5%). The average hemoglobin level was 5.5 g/dL; there was severe anemia in 94.1% of the girls (Hb <7g/dl). All the girls received blood transfusions with red blood cell concentrate. The other treatments received were local care (100%), administration of analgesics (100%), antibiotic therapy (82.4%), and oxygen therapy (41.2%). The outcome was unfavorable in two patients (11.8% deaths). CONCLUSION: This study shows the seriousness of the immediate complications associated with the practice of excision.

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Blood transfusion is an essential therapeutic tool in the treatment of sickle cell disease. Its indications and modalities vary from one country to another as a function of the clinical severity of the disease and the availability of blood products. This study seeks to evaluate the frequency and modalities of blood transfusions as well as their indications in patients with sickle cell syndrome at the Dakar hematology department from 1995 through 2015. This retrospective study reviewed the records of a cohort of 1078 patients with SS, SC, Sß0 and Sß + thalassemia sickle cell syndromes and collected data about the type of blood products, indications, modalities, and acute transfusion complications. The frequency of transfusion was adjusted for age, sex, and sickle cell profile. The patients' mean age was 23 years (2-44 years) and the sex ratio 0.9. SS disease was predominant (87.4 %); 28.5% had transfusions during the study period. Patients older than 20 years received more transfusions (P = 0.047). The frequency of transfusions did not differ significantly by gender (P = 0.12), but did by profile: a higher percentage of patients with SS disease required transfusion (P = 0.043). Acute anemia was the most common indication for transfusion (50.03 %). Acute transfusion complications were rare (5.8 %). This study shows that less than one third of sickle cell anemia patients in Senegal have transfusions, a finding that confirms that our patients have fewer transfusions than patients in other countries in Africa or in the West. This limited use of transfusion therapy may be related to a less severe level of disease among patients in Senegal, but also to the availability of blood products.

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Despite significant progres on haemophilia care in developed world, this disease remains unknown in many sub-Saharan African countries. The objectives of this article were to report Senegalese experience on the management of haemophilia care through 18 years of follow-up. This cohort study included 140 patients (127 haemophilia A, 13 haemophilia B), followed in Dakar's haemophilia treatment centre from 1995 to 2012. Our study reported a prevalence of 2.3/100,000 male births, accounting for 11.6% of what is expected in Senegal. From the period 1995-2003 to 2004-2012, significant progress was seen including 67.9% increase in new patient's identification, 11.3 years reduction in mean age at diagnosis (from 15.5 to 4.2 years), lower mortality rate (from 15.3% to 6.8%) and age at death evolved from 6.5 to 23.3 years. Of the 50 haemophilia A patients who were tested for inhibitor presence, 10 were positive (eight severe and two moderate) that is prevalence of 20%. All patients were low responders since inhibitor titre was between 1.5 and 3.8 BU. Disabilities were seen in 36.5% of patients above 20 years old who had musculoskeletal sequels and 39% had no scholar or professional activities in our setting. Implementing haemophilia care in sub-Saharan Africa is a great challenge as this disease is not yet counted in national health problems in many countries. Lessons learned from this study show a significant improvement in diagnosis and prognosis parameters. This emphasizes the needs to set up such follow-up initiatives and to enhance medical and lay cooperation for better results.

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Obturator muscles haematoma are rarely reported. The most often reported cases are primary pyomyositis or posttraumatic haematomas occurring during pelvic fractures. We firstly report herein two cases of spontaneous obturator internus haematoma (OIH) in two haemophiliacs with inhibitor. Clinical data and imaging of two patients treated in our clinic are reported here according to previously defined criteria of OIH in posttraumatic situation. Both patients were children suffering from severe and moderate haemophilia A, respectively, with an inhibitor at the time of the event. The clinical feature was marked by an iliopelvic pain letting discussing hip haemarthrosis, appendicitis or iliopsoas haematoma. For both patients ultrasonography (US) failed to provide the diagnosis. Careful and repeated clinical examinations eventually lead to suspect obturator haematoma which was confirmed by abdominopelvic computed tomography (CT) and magnetic resonance imaging (MRI). Respectively, high dose of FVIII or rFVIIa regimen allowed a rapid control of the muscular bleeding in the low and high responder inhibitor patients. Spontaneous OIH may be added to the differential diagnosis of iliopelvic pain in severe forms of haemophilia. US still often performed at first in such case remains unhelpful; abdominopelvic CT or MRI should be performed to discriminate among different diagnoses, including OIH which stays probably undiagnosed.

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AIM: The authors present the results of the first survey conducted among the population of the Futa Jallon province in Guinea on the prevalence of diabetes mellitus (DM) and impaired fasting glucose (IFG) and associated risk factors for diabetes. METHOD: A random sample of the study population selected by cluster house sampling method included 1537 Guineans (807 women and 730 men) aged 35 years and above in urban (Labé) and rural (Fellö Koundoua-Tougué) areas. Participants were examined and administered a capillary whole blood glycemia test. RESULTS: The mean age of subjects was 49.4 years. Participation rate was 77%. Overall crude diabetes and IFG prevalence were 6.1% and 13.4%, respectively. The age-adjusted prevalence of diabetes using the standardized age distribution of Segi was 6.7% (95% CI: 5.5-7.9%). Subjects in the urban area had twice as much DM as in the rural area (OR 2.0, 95% CI: 1.3-3.2). Out of the 94 subjects with DM, 66 had no prior history of disease. Urban location, age, waist to hip ratio, excess waist circumference, hypertension, raised systolic and diastolic blood pressures were significantly positively associated with DM. In multivariate analysis, only age (P=0.002) and waist circumference (P<0.05) remained independently associated with DM. CONCLUSION: The prevalence of DM was higher than expected in urban and rural areas. The data support the conclusion that prevalence of DM is expected to increase with the aging of the population. The factors associated with diabetes are potentially modifiable. Therefore, primary prevention through lifestyle modifications may play a critical role in the control of DM.

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The objectives of this transverse study were to clarify the prevalence of the hypertension in Foutah-Djallon in Guinea, the influence of the environment (rural or urban areas) and to identify the associated metabolic abnormalities (AMA) (hyperglycaemia, weighty excess). 1537 subjects of 35 and more years old living in urban zones (Labé, n=886) and in rural areas (Fellö-Koundoua in Tougué, n=651), were selected by a cluster sampling, and examined between February 1st and March 31st, 2003.The prevalence of the hypertension (blood pressure: BP > or = 140/90 mm of Hg) was 43.6% in urban areas, 14.9% in rural areas (p < 0.001). The subjects living in urban areas had more often a weighty excess and were more sedentary. Among them, 3.6% presented an AMA (waist measurement > or = 95 cms in the man and > or = 88 cms in the woman, BP > or = 130/85 mm of Hg, and fasting capillary blood glycaemia > or = 1.10 g/l) against 0.3% in the subjects living in rural areas. These results confirm the important role of the changes of way of life (urbanization and sedentary) in the increase of the prevalence of the hypertension and the AMA in Africa. Appropriate programs educational sanitary in wide scale are indispensable.

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INTRODUCTION: Thrombotic thrombocytopenic purpura failure (TTP) is a micro angiopathy caracterized in its severe form by multivisceral involement and early death. The association with pregnancy is rare, the diagnosis is difficult, but imperative because that will allow an early specific management and will improve the diagnosis CASE: Our patient is a 25 years old woman admitted in intensive care unit after cesarian section for eclampsia at term. Clinical and biological assessement were in favor at Hellp syndrome. Toxemia complicated with eclampsia and Hell syndrome was the final diagnosis and appropriate treatment followed. However the treatment, diffuse purpuric petechia appeared associated with jaundice, thrombocytopenia. The diagnosis of T.T.P was considered and corticotherapy started at day 8. Patient responded within 48 h and healins was complete after 5 weeks. CONCLUSION: Authors emphasized on the importance of the diagnosis and specific management.

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