Les urgences urologiques au CHU de Libreville aspects diagnostiques et délai de prise en charge / Urological emergencies at the University Hospital Center of Libreville: diagnostic aspects and management delay

Objectif : l'objectif de cette étude était de rapporter les aspects diagnostiques ainsi que les délais de prise en charge des urgences urologiques.Patients et Méthodes : nous avions réalisé une étude prospective à visée descriptive, du 1er juin 2018 au 31 mai 2019 au Centre Hospitalier Universitaire de Libreville. Elle concernait tous les patients reçus pour une urgence urologique.Les variables comprenaient les données socio démographiques, diagnostiques et thérapeutiques.Résultats : durant cette période, nous avions enregistré 586 patients. L'âge moyen était de 40,6 ans avec des extrêmes de 3 mois et 96 ans. Le sex ratio était de 4,6. Les urgences étaient obstructives (40,6%) et infectieuses (33,3%). Sur le plan thérapeutique, le geste effectué était le sondage vésical dans 33,5% des cas. Cent quarante (140) interventions chirurgicales (23,9%) avaient été réalisées. Le délai moyen de prise en charge était de 47,4 heures. Les principales causes du retard de prise en charge étaient la consultation tardive, la lenteur des formalités administratives et l'attente du kit chirurgical.Conclusion : les urgences urologiques demeurent des pathologies fréquentes. Elles sont dominées par les rétentions aiguës d'urine et les infections urogénitales dans notre contexte. Le cathétérisme urétral est le geste le plus réalisé au service des urgences chirurgicales. La stratégie de prise en charge requiert une évaluation clinique rigoureuse, un traitement précoce et efficace pour minimiser les séquelles.

Introduction: Urological emergencies are many and varied. The objective of this study was to report the diagnostic aspect as well as the time taken to manage urological emergencies. Patients and Methods: We carried out a prospective study with a descriptive aim, from June 1st, 2018 to May 31st, 2019 at the University Hospital Center of Libreville. It concerned all patients received for an urological emergency.The variables included socio-demographic, diagnostic and therapeutic data.Results: During this period, we registered 586 patients. The average age was 40.6 years with extremes of 3 months and 96 years. The sex ratio was 4.6. Emergencies were obstructive (40.6%) and infectious (33.3%). Therapeutically, the procedure performed was bladder catheterization in 33.5% of cases. One hundred and forty (140) surgeries (23.9%) were performed. The average recovery time was 47.4 hours. The main causes of the delay in treatment were late consultation, slowness of the administrative formalities and wait for the surgical kit.Conclusion: Urological emergencies remain frequent pathologies. They are dominated by acute urine retention and urogenital infections in our context. Urethral catheterization is the most common procedure in the surgical emergency department. The management strategy requires rigorous clinical evaluation, early and effective treatment to minimize sequelae

Evaluation des connaissances théoriques des étudiants en médecine sur les gestes de premiers secours en République Démocratique du Congo / Theoretical knowledge assessment of medical students on first aid in the Democratic Republic of Congo

Introduction: La République Démocratique du Congo fait régulièrement face à plusieurs urgences sanitaires. La présence des médecins en première ligne dans la riposte y est un phénomène spontané. Des lacunes ont été identifiées dans la connaissance des premiers secours au sein de la population; d'où la nécessité de formation. Les étudiants en médecine y joueraient un rôle crucial. Cette étude évalue les connaissances théoriques en premiers secours chez ceux-ci. Méthodologie: Notre étude est de type descriptif et transversal. Elle a été conduite du 01 Juin au 30 Août 2021 à la Faculté de médecine de l'Université Catholique du Graben. Notre échantillon était constitué de 279 étudiants. La collecte des données a été faite par un questionnaire d'enquête couvrant divers aspects des premiers secours. Les données ont été traitées par le logiciel Epi Info version 3.4.5. Résultats: Aucun participant n'a démontré un niveau satisfaisant de connaissances théoriques en premiers secours tandis que 38,7% et 61,3 % ont démontré un niveau intermédiaire et bas respectivement. Une corrélation positive a été notée entre la promotion d'étude, une formation antérieure en premiers secours et le niveau de connaissance. Le média est la principale source d'information. Près de la moitié des étudiants ont affirmé n'avoir jamais posé un geste de premier secours à cause du manque de connaissance (47,7%). La quasi-totalité a montré une attitude positive en rapport avec l'introduction d'une formation en premiers secours en milieu universitaire. Conclusion: Cette étude a démontré un faible niveau de connaissances des gestes de premiers secours parmi les étudiants en médicine, mais une volonté d'apprendre. Il y a nécessité d'intégrer la formation en gestes de premiers secours dans tous les curriculums de l'enseignement en RDC

Introduction: The Democratic Republic of Congo regularly faces several health emergencies. The presence of medical doctors in the first line of the response is a spontaneous phenomenon. Gaps in first aid knowledge have been identified in the population; hence the need for training. Medical students could play a crucial role in this context. This study assesses the theoretical knowledge of first aid among them. Methods: Our study is descriptive and transversal. It was conducted from June 01 to August 30, 2021 in the Faculty of Medicine of the Catholic University of Graben. Our sample consisted of 279 students. Data collection was done through a survey questionnaire covering various aspects of first aid. Data were processed using Epi Info software. The chi-square test was used to estimate the association of variables with knowledge and a p-value. Results: No participant demonstrated a satisfactory level of theoretical knowledge of first aid while 38.7% and 61.3% demonstrated an intermediate and low level respectively. A positive association was noted between the study level, a previous training in first aid and the level of knowledge. The media is the main source of information. Nearly half of the students said they had never taken a rescue action because of lack of knowledge (47.7%). The vast majority (98%) had a positive attitude regarding the introduction of first aid in school's curriculum. Conclusion: Our study showed a poor level of first aid knowledge among medical students, but a great willingness to learn. There is a great need to incorporate first aid trainings in all training curricula in the DRC.

Essential medicines for emergency care in Africa

Essential medicines lists (EMLs) are efficient means to ensure access to safe and effective medications.The WHO has led this initiative, generating a biannual EML since 1977. Nearly all countries have implemented national EMLs based on the WHO EML. Although EMLs have given careful consideration to many public health priorities, they have yet to comprehensively address the importance of medicines for treating acute illness and injury.Methods:We undertook a multi-step consensus process to establish an EML for emergency care in Africa. After a review of existing literature and international EMLs, we generated a candidate list for emergency care. This list was reviewed by expert clinicians who ranked the medicines for overall inclusion and strength of recommendation. These medications and recommendations were then evaluated by an expert group. Medications that reached consensus in both the online survey and expert review were included in a draft emergency care EML, which underwent a final in-person consensus process.Results:The final emergency care EML included 213 medicines, 25 of which are not in the 2017 WHO EML but were deemed essential for clinical practice by regional emergency providers. The final EML has associated recommendations of desirable or essential, and is subdivided by facility level. Thirty-nine medicines were recommended for basic facilities, an additional 96 for intermediate facilities (e.g. district hospitals), and an additional 78 for advanced facilities (e.g. tertiary centres).Conclusion:The 25 novel medications not currently on the WHO EML should be considered by planners when making rational formularies for developing emergency care systems. It is our hope that these resource-stratified lists will allow for easier implementation, and will be a useful tool for practical expansion of emergency care delivery in Africa

Risk factors and perinatal outcome of umbilical cord prolapse in Sagamu, Nigeria

Background: Umbilical cord prolapse is an obstetric emergency that threatens the life and well-being of the fetus and also increases maternal morbidity. Fetal survival in umbilical cord prolapse can be enhanced by prevention where risk factors are identified and prompt diagnosis and decisive intervention.Objective: The aim of this study was to determine the incidence, identify the risk factors associated with umbilical cord prolapse and document the perinatal outcome of cases of cord prolapse.Methods: This was a 13-year retrospective case-control study of cases of umbilical cord prolapse seen at the OOUTH, Sagamu, Southwestern Nigeria between January 1, 2000 and December 31, 2012.Result: During the study period, the incidence of umbilical cord prolapse was 1 in 122 deliveries (0.82%). The umbilical cord prolapse occurred in association with breech presentation five times (33.3%) and transverse lie eleven times (18.5%). The occurrence of breech presentation among the control cases was 8.6% (p<0.001) and that of transverse lie was 1.9% (p<0.001). There were also significant statistical differences between the cases of cord prolapse and controls in terms of prematurity, low birth weight, unbooked status and multiparity. The perinatal rate was 222/1000 (22.2%) compared to the perinatal mortality of 68/1000 (6.8%) for the control group.Conclusion: It is suggested that pregnant women should be encouraged to register early in pregnancy for antenatal care as this will enhance early identification of the risk factors and appropriate management instituted to reduce perinatal mortality

Exposure to daily trauma: the experiences and coping mechanism of emergency medical personnel. A cross-sectional study

To investigate the experience and coping mechanisms used by Emergency Medical Services (EMS) personnel following exposure to daily or routine traumatic events. Methods A total of 189 respondents from three EMS in the Cape Town Metropole completed a questionnaire; containing close-ended quantitative questions. This was followed up by a semi-structured interview in order to get greater insight from in-depth qualitative data. Results The significant results of this study indicate that EMS personnel find dealing with seriously injured children most traumatic. They experience avoidance symptoms after exposure to a traumatic incident and apply emotion-focused coping to help them deal with their emotions. Very little or no training has been received to prepare them for the emotional effects of traumatic incidents or how to deal with the bereaved family; and there was consensus amongst the participants that their company debriefings and support structures are inadequate. Conclusion : EMS personnel are exposed to critical incidents on a daily basis. Commonly used emotion-focused coping mechanisms are not effective in long-term coping. A key recommendation emanating from this finding is that integrated intervention programmes are needed to assist EMS personnel working in this sustained high-stress environment. The findings can assist health care educators in the design of co-curricular activities intended to help in the development of resilience and the psychological wellbeing of EMS personnel. Policy makers and EMS managers may find the results useful as they evaluate the effectiveness of their current debriefing and support structures

Neurologic emergencies in resource-limited settings: a review of stroke care considerations

Background: The current guidelines and evidence supporting acute stroke management have limitations in resource austere environments despite being a leading cause of death worldwide. Developing countries face a rapidly increasing and disproportionate burden of cerebrovascular disease yet differences in setting and resource limitations bring challenges that have a major influence in management options - especially with routine imaging and interventional considerations. In addition; general awareness; diagnosis and management of stroke remain poor.Objectives :To outline current acute stroke management and critical interventions that should be integrated into current practice while highlighting resource-limited care considerations.Methods :A systematic search of Ovid MEDLINE and reference lists of the literature on stroke; guidelines; and acute stroke management including care considerations in resource-limited settings was conducted through March 2014. Recommendations :Within emergency medicine; emphasis should be placed on establishing a robust stroke assessment and care process that is resource appropriate and scalable. Adherence as resources allow to current stroke care guidelines including acute management; stroke center coordination; palliation and resource allocation may improve outcomes. Further research related to resource-limited management is essential. Risk reduction through population-based interventions and early recognition may help to reduce the burden of disease

Essentials for emergency care: lessons from an inventory assessment of an emergency centre in Sub-Saharan Africa

Introduction:The World Health Organization (WHO) has published lists of essential equipment and supplies for delivering emergency care in resource-limited settings. The objective of this study was to assess material resources available for adult emergency care at a major academic tertiary care referral centre in Accra; Ghana; to determine quality improvement needs.Methods A spot inventory of emergency centre equipment and supplies was conducted in Korle-Bu Teaching Hospital (KBTH) and compared to the WHO essential emergency equipment list released in 2006. Results :Most items considered essential were available at the time of inventory. Notable exceptions included: equipment and supplies for healthcare provider safety and infection control; advanced airway management; and ophthalmologic or gynaecological examinations. Several additional items; such as glucometers and pulse oximeters; were available and often used for patient care. Conclusion:Beyond pointing out specific material resource deficiencies at the Surgical Medical Emergency (SME) centre; our inventory assessment indicated a need to develop better implementation strategies for infection control policies; to collaborate with other departments on coordination of patient care; and to set a research agenda to develop emergency and acute care protocols that are both effective and sustainable in our setting. Equipment and supplies are essential elements of emergency preparedness that must be both available and 'ready-to-hand'. Consequently; key factors in determining readiness to provide quality emergency care include supply-chain; healthcare financing; functionality of systems; and a coordinated institutional vision. Lessons learnt may be useful for others facing similar challenges to emergency medicine development

Emergency Obstetric Hysterectomy in a Tertiary Hospital in Sokoto; Nigeria

Emergency obstetric hysterectomy (EOH) is a life-saving procedure which is often performed to treat some obstetric complications; as a last resort; to prevent maternal mortality. Objectives: This study was designed to determine the rate; indications; and complications of the EOH procedure at Usmanu Danfodito University Teaching Hospital (UDUTH); Sokoto. Materials and Methods: This retrospective study involved all the patients who had EOH at UDUTH; Sokoto; Nigeria; between January 2005 and December 2010. The case records of these patients were retrieved from the medical record library and information relating to age; parity; booking status; indications; type of hysterectomy; cadre of the surgeon; type of anesthesia; and complications of the procedure were extracted. The data were processed via SPSS version 11.5 and the ?2 test was used to analyze some of the results with the confidence limit set at 95. Results: During the 6-year period; 83 EOH were performed out of 16;249 deliveries giving the rate of the former as 0.51; i.e. 1 in 196 deliveries. However; the case records of only 74 patients (82.9) were available for the study. The rate of EOH increased with advancing maternal age and increasing parity. The majority of the patients (89.2) were available for the study. The rate of EOH increased with advancing maternal age and increasing parity. The majority of the patients (89.2) were unbooked for antenatal care; and the rate of the procedure among these patients (1.82) was significantly higher than 0.07observed amongst booked subjects (P0.001). The main indication for the procedure was ruptured uterus (93.2) and the majority of the patients (95.9) had subtotal hysterectomy. Anemia (66.2); excessive hemorrhage (35.5); septicemia (18.9); and wound infection (16.2) were the leading complications. Excessive hemorrhage was significantly higher in the procedure performed by the senior registrars (51.2) compared to those undertaken by consultants (16.2); P

Injuries in Children and Adolescents seen during 2006 at the Emergency Department of the National District Hospital; Bloemfontein

Most children and adolescents recover fully from injuries. However; permanent disabilities may occur. The objective of the study was to investigate the prevalence and profile of injuries in children and adolescents five to 19 years of age seen at the emergency department of the National District Hospital in Bloemfontein. Methods: A retrospective descriptive study was conducted. Demographic and injury-specific information obtained from hospital records of 2006 was entered into a data-capturing form. Data were analysed by using descriptive statistics.and 43.5 of injuries occurred in the age group 15 to 19 years. Approximately half (51.7) were Afrikaans-speaking and resided in suburban areas (50). Most injuries occurred at home (40.2) between 12h00 and 17h00 (38.7). Falls (33.7) were the most common cause of injury. Soft tissue injuries (35.9) occurred most commonly; fol lowed by lacerations (33.0) and fractures (16.7). Upper limb injuries (42.1) were seen more than lower limb injuries (27.8). Facial injuries occurred in 12 of cases. X-rays were performed in 57.9 of cases. Most patients (93.3) received medication; while 22 were referred for specialist treatment. All cases except one were discharged from the emergency department. Parents accompanied patients in 65.6 of cases. Results: The prevalence of injuries in this age group was 20.3. Two hundred and nine records were investigated. The majority of cases were male (68.3). The median age was 15 years; Conclusions: Optimal treatment should be given to the injured child or adolescent to avoid possible long-term injuryrelated sequelae. Preventive strategies should be formulated; enforced and evaluated

Audit of referral of obstetric emergencies in Angola: a tool for assessing quality of care

By auditing various aspects of referrals of obstetric emergencies, we wanted to study the effectiveness over time of a recently established network of peripheral birth units and two central hospitals in Luanda. 157 women referred for obstetric emergencies were studied regarding clinical outcome and process indicators like waiting time, partogramme quality and Caesarean section rate (CSR). After a change in routines at hospital admission and further partogramme education 92 referred women were compared with the former. Maternal mortality decreased from 17.8% to nil in the second. Total mean waiting time was reduced from 13.7 hours to 1.2 hours. Partogramme quality was significantly improved. CSR increased from 13 to 30%. Prolonged labour was the most common diagnosis.This study demonstrates the importance of clinic-based audit to enhance quality of care regarding referrals of patients with obstetric emergencies (Afr J Reprod Health 2009; 13[2]:75-85)

Anaesthetic Management of Surgical Emergencies

Anaesthesia for surgical procedures carries some risks. These risks are accentuated when the surgical operation is performed as an emergency procedure. The value of emergency in risk stratification underscores its relevance in clinical anaesthesia. Limited time for evaluation of patient; potential fluid/electrolyte imbalance; the `full stomach' situation and probable uncontrolled pain constitute major considerations in the administration of anaesthesia for emergency surgery. This expose seeks to discuss some of the clinical scenarios that are apt to emergency anaesthesia and in particular; the associated common clinical dilemmas

Emergency Caesarean Section in a Nigerian Tertiary Health Centre

Background: Caesarean delivery is an important aspect of emergency obstetric care and a major tool in the reduction of maternal and perinatal morbidity and mortality. This study was done to determine the caesarean section rate; ascertain the trend of emergency caesarean section; indications for emergency caesarean section and emergency caesarean morbidity and mortality at the Federal Medical Centre Makurdi. Method: A retrospective analysis of the clinical records of all patients delivered by caesarean section between January 2004 and December 2006 at the Federal Medical Centre Makurdi in north central Nigeria was conducted. Results: There were 4011 deliveries with 420 caesarean sections during the review period giving a caesarean section rate of 10.5. Emergency caesarean sections accounted for 351 (83.6) caesarean deliveries. The rate of emergency caesarean section decreased from 89.7in 2004 to 77.2in 2006. The leading indication for emergency caesarean section was cephalopelvic disproportion; accounting for 138 (39.3) cases; while antepartum haemorrhage and foetal distress followed in that order. There were 9 maternal deaths associated with emergency caesarean section giving a caesarean mortality rate of s 2.1Conclusion: Emergency caesarean sections account for 5 out of every 6 caesarean deliveries in our centre with a decreasing trend relative to elective caesarean sections. The emergency caesarean mortality is high

Emergency Ear; Nose throat Administrations at the Korle-Bu Teaching Hospital

Background: Ear Nose and Throat (ENT) emer-gencies are common in all communities. Early diagnosis and prompt management will result in reduction in morbidity and mortality.Objectives: To assess the size and distribution of ENT emergencies; obtain base line data and out-line preventive measures.Design: Clinical records of patients admitted for ENT emergency care at the Korle Bu Teaching Hospital from 1st January 2000 to 31st December 2002 were studied with respect to sex; age; diag-nosis on admission and outcome of emergency care. Exclusion criteria were admissions for termi-nal cancer care.Results: A total of 750 patients made up of 476 males and 274 females were admitted for emer-gency care. The age range was 1 month to 100 years; mean age was 25.5 years and median age was 18.23 years. The commonest causes of emer-gency admissions were foreign bodies in the oe-sophagus in 310 (41.3