Clinical characteristics of people with diabetic ketoacidosis at a clinic in The Gambia: a retrospective study

Background: Diabetic ketoacidosis (DKA) remains an important cause of hospitalisation and death in people with diabetes mellitus (DM) living in low- and middle-income countries. The clinical profile of patients with DKA varies, and maybe contributory to the outcomes observed globally. The aim of this study was to describe the clinical characteristics of people with diabetic ketoacidosis (DKA) seen at a clinic in The Gambia during a one-and-a-half-year period. Methods: This was a retrospective chart review that included people with DM who were seen from June 2017 to December 2018 at the Medical Research Council the Gambia at London School of Hygiene and Tropical Medicine. Biodata, anthropometric and admissions data were extracted for all patients from the electronic medical records system. Data were analysed for differences in clinical and biochemical characteristics on admission for DKA. Results: In total, 23 out of 103 admissions for people with DM were for a diagnosis of DKA during the study period. Sixteen of those included were females and the mean age of all patients was 35 ± 13 years. Two people had type 1 DM and 15 people were categorised as type 2 DM. DM was diagnosed for the first time during admission for DKA for 12 people and 6 people had confirmed sepsis. There were no significant differences in age at diagnosis of DM or biochemical characteristics. Conclusion: DKA was a common indication for admission for people with DM in the Medical Research Council the Gambia at London School of Hygiene and Tropical Medicine and the majority of patients with DKA had type 2 DM. Further studies are needed to describe DKA in this setting more accurately.

Profil glucido-lipidique et risque cardiovasculaire chez les diabétiques de type 2 / Carbohydrate and lipid profile associated with cardiovascular risk in type 2 diabetics

Introduction-Le diabète est un véritable problème de santé publique du fait de ses nombreuses complications potentielles, notamment cardiovasculaires. Notre objectif était de décrire le profil clinico-biologique chez une population de diabé tique type 2 et d'étudier la relation entre l'équilibre glycémique et les anomalies lipidiques avec les complications micro et macroangiopathiques. Matériels et méthodes -Nous avons mené une étude rétrospective portant sur 341 pa tients diabétiques type 2.Les données ont été analysées par le logiciel IBM® SPSS statis tics 20.0. Seules, les associations significatives (p ≤ 5%) étaient retenues. Résultats - quatre-vingt deux pourcent et demi des patients ont un taux d'HbA1c ≥7 %. Plus de 60 % ont une dyslipidémie. Cinquante deux pourcent des patients ont un taux du LDLc ≤ 1 g/l, et 64,4 % ont un taux du Non-HDLc >1g/l. Environ 66 % des patients ont une hypertension artérielle. quarante pourcent des patients ont présenté une macroangio pathie et 66,8 % une microangiopathie (p=0,0001). L'analyse par régression logistique, a montré que l'HbA1c est le paramètre biologique le plus associé aux complications macroangiopathiques (p=0,008), alors que pour les complications micro-angiopathiques, l'HTA était le seul facteur associé (p = 0,03). Pour la cardiopathie ischémique, la dyslipi démie et l'HTA étaient les facteurs les plus associés. Conclusion -Notre étude a montré une fréquence élevée des complications micro et macroangiopathiques et des anomalies lipidiques, ainsi qu'un très mauvais équilibre glycémique. L'HbA1c, la dyslipidémie et l'HTA sont les facteurs les plus associés au risque cardiovasculaire.

Background-Diabetes is a real health public problem because of its many potential complications, particularly the cardiovascular ones.The aim of this work was to describe the clinical and biological profile in type 2 diabetic population, then to study the relationship between glycemic control and lipid abnormalities with micro and macro vascular complications. Methods - It was about a retrospective study of 341 type 2 diabetes patients' with an average age of 60.1 ± 11.71 years.The IBM® SPSS statistics 20.0 software was used for analyzing data. Only significant associations (p ≤ 5%) were retained. Results -An HbA1c level ≥7% was observed in 82,5% of patients, More than 60% have dyslipidemia. 52,8% of them have an LDLc level ≤ 1 g/l, and 64,4% have a Non-HDLc level >1g/l. Sixty-six percent of patients have high blood pressure. The macrovascular disorders were observed on 30,9% of patients and microvascular ones on 66,8% of them (p = 0.0001).The logistic regression analysis showed that HbA1c was the most significant biological parameter (p=0,008). while for micro-vascular complications, high blood pressure was the only associated factor (p = 0.03). For ischemic heart disease, dyslipidemia and high blood pressure were the most associated factors. Conclusion - this study showed a high frequency of micro and macrovascular complications, lipid abnormalities and a very poor glycemic control. The elevation of HbA1c level, the high blood pressure and dyslipidemia are the most associated factors with a high cardiovascular risk.

Time to Diabetic Retinopathy and Its Risk Factors among Diabetes Mellitus Patients in Jimma University Medical Center, Jimma, Southwest Ethiopia

Diabetic retinopathy is a complication of diabetes, caused by high blood sugar levels damaging the eye. Globally, diabetic retinopathy affects more than 103.12 million people. Diabetic retinopathy is among the leading causes of vision loss at the global level, including in Ethiopia. Therefore, the study aimed to assess the time to develop diabetic retinopathy and identify factors associated with diabetic retinopathy among diabetes patients. METHODS: A retrospective study was conducted from September 1, 2021, to January 30, 2022. Data was collected using semi structured questionnaire. The Cox proportional hazard model were used to determine the median time to develop diabetic retinopathy and identify predictors of diabetic retinopathy. Data was analyzed using R software. RESULTS: A total of 373 diabetes patients were included in this study. The prevalence of diabetic retinopathy was 41.3%. The median time was 41 months, ranging from 39 to 73 months. Elder age (HR=3.17, 95%CI: 1.53, 6.58), being male (HR=2.34, 95%CI: 1.35,6.15), previous family history of diabetes (HR=4.16, 95%CI: 2.19, 8.37), longer duration of diabetes (HR=2.86, 95%CI: 1.41, 5.31) received only insulin therapy (HR=3.91, 95%CI: 1.36, 7.94), and high systolic blood pressure (HR=2.32; 95%CI: 1.12, 4.39) were statistically significant factors related to development of diabetes retinopathy. CONCLUSIONS: More than half of diabetic patinets in this study were developed retinopathy diabetes within a few months of being diagnosed. As a result, we advocate that the best way to preserve our vision from diabetic retinopathy is to maintain our diabetes under control, and the high-risk population receive early screening for diabetes

Content analysis of the South African MMed mini-dissertation

Background. There is no baseline information on the South African (SA) MMed mini-dissertation, which became a compulsory (and controversial) research component for specialist registration in 2011.Objective. To obtain evidence-based information regarding the current composition of the research output of the MMed mini-dissertation.Methods. SA MMed mini-dissertations (N=307) were downloaded from electronic theses and dissertation websites and 8 university repositories that provide specialist training. Fourteen variables were noted for each mini-dissertation, the data were entered into an Excel (2016) (Microsoft, USA) spreadsheet and analysed using descriptive statistics.Results. The 307 mini-dissertations, representing 24 of the Colleges of Medicine of SA, were submitted from 1996 to 2018, mainly in monograph format (76%) and almost equally divided between prospective and retrospective studies. Observational studies predominated, with meta-analyses, systematic reviews and randomised controlled trials comprising 5% of the sample. Although quantitative investigations dominated (82%), just less than half of these used statistics to test variables. Confirmed ethical compliance improved from 41% in pre-2011 dissertations to 83% for dissertations submitted during 2015 - 2018.Conclusions. This study provides descriptive data on the SA MMed mini-dissertation. Comparisons indicate that the MMed research component compares favourably with the content and research approach of similar international specialist trainee research outputs

A 6-year review of post-neonatal tetanus at Usmanu Danfodiyo University Teaching Hospital, Sokoto

Background: Tetanus is a vaccine-preventable disease but its incidence has remained unacceptably high in developing countries. Objective: To determine the prevalence, risk factors and outcome of post-neonatal tetanus at Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto. Methods: A retrospective descriptive study from 1st January 2010 to 31st December 2015. Children aged 1 month to 15 years diagnosed with post-neonatal tetanus were studied. Information from the admission files was extracted. Data was analysed using SPSS version 20. Results: Total admissions during the study period were 14,458; 61 had post-neonatal tetanus, giving a prevalence of 0.4%. The M: F ratio was 1.5:1. The mean age was 7.4±3.2 years. Fifty-nine (96.7%) were not immunised against tetanus. Portal of entry for the organism was trauma injuries to the foot in 33(54.1%). Thirty-one (50.8%) were discharged, 5(8.2%) DAMA, while 25(41.0%) died, and case fatality was 41.0%. Conclusion: Post-neonatal tetanus is a major cause of morbidity and mortality in Sokoto. There is need for improved health education, sustainability of immunisation programmes and coverage to eradicate this scourge

Bilan de 24 mois d'activités neurochirurgicales au centre hospitalier régional Lomé commune (Togo)

Objectif: Présenter et discuter les résultats de l'activité neurochirurgicale au Centre Hospitalier Régional Lomé Commune.Patients et Méthode:Nous avons mené une étude rétrospective de Juillet 2014 à Juillet 2016, incluant les patients opérés pour une affection neurochirurgicale. Les paramètres étudiés étaient épidémio- logiques, diagnostiques, chirurgicaux et évolutifs. Résultats:Cent quatre-vingt-douze patients ont été opérés. Leur âge moyen était de 42,14 ans [0-72]. Le sex ratio étaitde 1,94 en faveur des hommes. La durée moyenne du séjour hospitalier en post opératoire était de 8,2 jours. Les affections dégénératives du rachis ont été la première pathologie concernée par la chirurgie (49,48%), suivies des traumatismes du rachis (17,19%). L'évolution a été favorable dans 90,1% des cas, pour l'ensemble de la série. Nous avons noté 1,6% de cas d'infection du site opératoire, sur l'ensemble de la série. Conclusion : Les résultats sont encourageants pour l'ensemble de la série. L'essor de la pratique neurochirurgicale au Togo nécessite la création d'unités neurochirurgicales indépendantes, une amélioration du plateau technique et une coopération multidisciplinaire

Retrospective review of the patient cases at a major trauma center in Nairobi, Kenya and implications for emergency care development

Introduction:Low- and middle-income countries (LMICs) are continuing to experience a "triple burden" of disease - traumatic injury, non-communicable diseases (NCDs), and communicable disease with maternal and neonatal conditions (CD&Ms). The epidemiology of this triad is not well characterised and poses significant challenges to resource allocations, administration, and education of emergency care providers. The data collected in this study provide a comprehensive description of the emergency centre at Kenya's largest public tertiary care hospital.Methods:This study is a retrospective chart review conducted at Kenyatta National Hospital of all patient encounters over a four-month period. Data were collected from financial and emergency centre triage records along with admission and mortality logbooks. Chief complaints and discharge diagnoses collected by specially trained research assistants were manually converted to standardised diagnoses using International Classification of Disease 10 (ICD-10) codes. ICD-10 codes were categorised into groups based on the ICD-10 classification system for presentation.Results:A total of 23,941 patients presented to the emergency centre during the study period for an estimated annual census of 71,823. The majority of patients were aged 18-64 years (58%) with 50% of patients being male and only 3% of unknown sex. The majority of patients (61%) were treated in the emergency centre, observed, and discharged home. Admission was the next most common disposition (33%) followed by death (6%). Head injury was the overall most common diagnosis (11%) associated with admission. Conclusions:Trends toward NCDs and traumatic diseases have been described by this study and merit further investigation in both the urban and rural setting. Specifically, the significance of head injury on healthcare cost, utilisation, and patient death and disability points to the growing need of additional resources at Kenyatta National Hospital for acute care. It further demonstrates the mounting impact of trauma in Kenya and throughout the developing world

The burden of acute coronary syndrome, heart failure, and stroke among emergency department admissions in Tanzania: A retrospective observational study

Introduction The prevalence of cardiovascular disease in sub-Saharan Africa is substantial and growing. Much remains to be learned about the relative burden of acute coronary syndrome (ACS), heart failure, and stroke on emergency departments and hospital admissions.Methods A retrospective chart review of admissions from September 2017 through March 2018 was conducted at the emergency department of a tertiary care center in northern Tanzania. Stroke admission volume was compared to previously published data from the same hospital and adjusted for population growth. Results Of 2418 adult admissions, heart failure and stroke were the two most common admission diagnoses, accounting for 294 (12.2%) and 204 (8.4%) admissions, respectively.ACS was uncommon, accounting for 9 (0.3%) admissions. Of patients admitted for heart failure, uncontrolled hypertension was the most commonly identified etiology of heart failure, cited in 124 (42.2%) cases. Ischemic heart disease was cited as the etiology in only 1 (0.3%) case. Adjusting for population growth, the annual volume of stroke admissions increased 70-fold in 43 years, from 2.9 admissions per 100,000 population in 1974 to 202.2 admissions per 100,000 in 2017.Conclusions :The burden of heart failure and stroke on hospital admissions in Tanzania is substantial, and the volume of stroke admissions is rising precipitously. ACS is a rare diagnosis, and the distribution of cardiovascular disease phenotypes in Tanzania differs from what has been observed outside of Africa. Further research is needed to ascertain the reasons for these differences

The outcome of patients on hemodialysis at university teaching hospital of Kigali (CHUK) in a period of september 2014 to march 2017 - A retrospective study on patients with acute and chronic renal failure

Background: Kidney dysfunction is both a national and international problem. Its incidence is increasing in the general population, mostly due to the high prevalence of diabetes, hypertension and the long-term consequences of acute kidney injury. The incidence and prevalence of kidney dysfunction necessitating dialysis are unknown in Rwanda as studies are lacking.Methodology: This study describes the outcomes of the patients who received hemodialysis at CHUK. Data was retrospectively collected and statistically analyzed for 152 patients treated in the hemodialysis unit at CHUK between September 2014 and March 2017.Results: The results have shown that 51.3% and 48.7% of the population being studied were identified to have acute kidney injury and chronic kidney failure respectively. The main risk factors for hemodialysis treatment were hypertension (48%), diabetes mellitus (46.7%), eclampsia (13.2%), and volume deficit (15.8%). Hyperkalemia, pulmonary edema, encephalopathy, and other uremic symptoms were present in 39-43% of patients and were the most common indications for hemodialysis. Encephalopathy and poor oxygen saturation were independent risk factors for death. 20.6% could not afford the usual provision of three sessions of hemodialysis per week and therefore didn't receive dialysis as frequently as recommended. Forty-five patients (20.6%) could not afford the usual provision of three sessions of hemodialysis per week and received less frequent dialysis.Conclusion: There is high mortality in patients referred for hemodialysis in CHUK. Almost half of the patients have chronic renal failure and require permanent renal replacement therapy. Many patients limit therapy due to financial reasons

Demographics of paediatric patients presenting with acute appendicitis: A 5-year retrospective review of hospitals served by the Department of Paediatric Surgery at the University of the Witwatersrand

Background. There are no recently published data on the incidence and demographics or perforation rates of paediatric patients from our local population presenting with acute appendicitis. Objective. To show the age and gender distribution of paediatric patients presenting with acute appendicitis within our communities, as well as demonstrating the incidence of perforated acute appendicitis in our paediatric population. Method. The study is a retrospective record review of all paediatric patients who presented with acute appendicitis to the Department of Paediatric Surgery at both Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), and Chris Hani Baragwanath Academic Hospital (CHBAH) from June 2010 to September 2015. Data collected included all demographic data as well as histology results of patients who underwent appendectomies. Results. The total numbers of patients included in the study were 544; 234 at CHBAH, and 311 at CMJAH. The male-to-female ratio was 1.58:1. The mean age for presentation at both hospitals combined was 8.76 years. We found that 13.41% of paediatric patients with acute appendicitis in this cohort were under the age of 6 years. A histological review showed that 50.1% of patients in our cohort presented with complicated appendicitis, and we had a negative appendectomy rate of 8.4%. Histological results of patients under the age of 6 years revealed a higher negative appendicectomy rate of 11.4%. However, the incidence of complicated appendicitis in this age group was only 45.7%, which is lower than that reported in the literature. Three patients were found to have Enterobius vermicularis in the lumen of the appendix, and Ascaris ova were identified in one patient. Histology revealed a low-grade mucinous neoplasm in one patient. Conclusion. Acute appendicitis occurred at a median age of 8.76 years in our study population, with a male-to-female ratio of 1.58:1. We found that acute appendicitis occurred relatively more frequently in our patients under the age of 6 years compared with the incidence of acute appendicitis in this age group published elsewhere. Complicated appendicitis occurred in 50.1% of our patient population, with an increased frequency of perforated appendicitis occurring in our male population. However, complicated appendicitis occurred in only 44.7% of our patients below the age of 6 years, which is in stark contrast to published literature. Helminthic infections were rare associated pathogens in our study, and an unlikely underlying pathogen of acute appendicitis in our population

Résultats de l'hémiarthroplastie pour fracture du col du fémur au centre hospitalier universitaire départemental de l'Ouemé Plateau (CHUDOP) au Bénin

Introduction : Les fractures du col du fémur font parties des fractures les plus typiques et les fréquentes de la traumatologie gériatrique. Le but de cette étude était d'évaluer les résultats de l'hémiarthroplastie comme traitement des fractures déplacées du col du fémur dans notre contexte de travail. Méthode : Il s'agissait d'une étude rétrospective de patients opérés entre le 1er janvier 2009 et le 31 décembre 2016 et incluant tous les patients admis pour fracture du col du fémur. Résultats : Le délai moyen d'hospitalisation était de 11 jours (6 et 34 jours). Au plan anatomique, Au plan anatomique, les têtes prothétiques étaient de tailles appropriées dans 15/16 cas. Les tiges étaient en position neutre dans 13cas, en varus dans 1 cas et en valgus dans 2 cas. L'embase prothétique était bien appliquée sur le moignon du col dans 14/16cas. Au dernier recul on notait en ce qui concerne les prothèses de Moore, un cas de cotyloïdite. Les complications postopératoires étaient 1 cas de luxation postérieure de prothèse de Moore à J1 postopératoire, 1 cas d'infection du site opératoire intéressant 1 prothèse intermédiaire et 1 cas de cotyloïdite sur prothèse de Moore. Au plan fonctionnel, le score moyen de Parker au dernier recul (pour les 12 survivants) était de 8. Conclusion : L'hémiarthroplastie est le traitement de référence des fractures du col du fémur de la personne âgée. Le choix de l'implant dépend dans notre milieu de travail de la capacité financière et de l'autonomie du patient

A retrospective study of lower limb cellulitis in a regional hospital in Ghana

Background: Cellulitis is a non-necrotizing inflammation of the dermis of skin and subcutaneous tissues. Lower limb cellulitis is a common cause of hospitalization in Ghana but scarcely reported. Objective: To document management and outcomes of lower limb cellulitis at the Ashanti Regional Hospital in Ghana. Materials and Methods: Retrospective review of patients admitted to the Ashanti Regional Hospital with a diagnosis of lower limb cellulitis from November 2016 to October 2018. We reviewed patients' clinical records for data on patient demographics, risk factors, clinical presentation, treatment modality and outcome of cellulitis. A p-value of less than 0.05 was considered to be statistically significant. Results: Eighty two (82) patients with lower limb cellulitis were admitted over the study period. There were 47 (57.3%) females and 35 (42.7%) males. The mean age of patients was 38.8 years (standard deviation 21.6065). Among females, the majority, 10 (21.3%) were in the 6th decade whilst the majority, 9 (25.7%) of males were in the 4th decade. All the patients presented with swelling of the lower limb involving the left lower limb in 38(46.3%) and right in 44(53.7%) cases. The leg was the most common location involved 60 (73%). The mean duration of swelling prior to admission was 5. 2 days (SD 3.196). Antibiotics treatment resulted in complete resolution in 29 (35.4%) cases and complications in 53 (54.5%), cases requiring surgical treatment in 31(58.5%) patients. Conclusion: Lower limb cellulitis had a high complication rate influenced by duration of symptoms prior to hospitalization and antibiotic therapy

Profil épidémiologique, clinique et valeur diagnostique des anticorps anti-Jo1 (anticorps anti-aminoacyl-t-RNA-synthétases). Etude rétrospective à propos d'une série de 22 patients

Propos : Notre objectif était de rapporter les caractéristiques épidémiologiques et cliniques de 22 patients avec anticorps anti-Jo1 positifs.Patients et méthodes : Etude rétrospective menée dans les services de Médecine interne et d'immunologie (Sfax-Tunisie) entre 2010 et 2016. Le dépistage des Anticorps Anti-Nucléaires (AAN) était réalisé par Immuno-Fluorescence Indirecte (IFI) sur cellules Hep2. Chaque sérum positif était testé par immunodot. Résultats : Vingt-deux patients ont été étudiés : 18 femmes et 4 hommes (âge moyen : 46 ans). Les principales manifestations cliniques étaient les signes rhumatologiques : 14 cas (63%), les signes généraux : 11 cas (50%), les manifestations musculaires : 8 cas (36%), les signes pleuro-pulmonaires : 8 cas (36%), les signes cutanés : 9 cas (45%), un phénomène de Raynaud : 2 cas (9%) et des mains de mécaniciens : 2 cas (9%). Le diagnostic d'une myosite de chevauchement était retenu chez 6 patients dont 4 avaient un Syndrome des Anti-Synthétases (SAS). Le diagnostic de maladies auto-immunes ou systémiques était retenu chez 9 malades. Le diagnostic de maladie non auto-immune était établi chez 7 patients. Tous les patients avaient des anti-Jo1 positifs associés avec l'anti- Ro52 (11 cas), l'anti-SSA (7 cas), l'anti-SSB (17 cas), l'anti-Sm (2 cas), l'anti-AND (1 cas), l'anti-centromère (3 cas) et l'anti Scl-70 (3 cas). Conclusion : Notre étude montre la rare prévalence des anticorps anti-Jo1, suggère l'intérêt de les rechercher devant un contexte évocateur et de façon systématique en cas de myosite ou d'atteinte pulmonaire interstitielle ou de fluorescence cytoplasmique des AAN

Sarcomes du sein. Etude rétrospective à propos de 12 cas et revue de la littérature

Introduction : les sarcomes du sein sont des tumeurs malignes rares qui se développent aux dépens du tissu mésenchymateux mammaire. Ils constituent un groupe très hétérogène de néoplasie mammaire dont le point commun reste la différenciation tissulaire conjonctive. Ils représentent environ 1% de l'ensemble de néoplasies mammaires et moins de 5% de tous les cancers des tissus mous de l'organisme. Leur diagnostic est anatomo-pathologique. Le but de notre travail était d'analyser les aspects épidémiologiques, cliniques, paracliniques, thérapeutiques et évolutifs de ces tumeurs et de confronter nos résultats à ceux de la littérature. Méthodologie : Il s'agit d'une étude rétrospective descriptive réalisée sur une période de dix(10) ans (du 1er Janvier 2007 au 31 Décembre 2016). L'étude a concerné tous les patients de deux sexes, quel que soit l'âge, atteints de sarcome mammaire et ayant une preuve histologique pendant la période de notre étude. Résultats : au terme de notre enquête, nous avons colligé douze(12) cas. Notre fréquence globale était de 1,25%. Il s'agissait de onze(11) femmes et d'un homme d'âge moyen de 32,58 ans avec des extrêmes de 18 et 45 ans. Les 3 /4 avaient un âge inférieur à 40 ans, 45,5% de nos patientes étaient nullipares, et une seule était ménopausée au moment du diagnostic. Deux(2) avaient pris de contraception orale. 41,7% de nos patientes avaient un ATCD personnel de pathologie tumorale mammaire bénigne : une pour tumeur phyllode, deux(2) pour adénofibrome et deux(2) pour nodule sans précision de la nature histologique. On note aussi un ATCD familial au 1er degré de mastopathie non documentée chez deux patientes (16,67%). Le délai moyen de consultation était de sept(7) mois et tous les patients avaient consulté pour nodule mammaire. La taille tumorale moyenne était de 9,07 cm, avec une localisation au niveau du sein droit dans 58,33%. La présence d'adénopathie axillaire a été notée chez 25% de nos patients avec un seul envahissement ganglionnaire à l'histologie. L'imagerie a été peu contributive, la cytologie mettait en évidence soit des lésions bénignes, soit des lésions carcinomateuses sans précision du type histologique. Le diagnostic positif n'a été définitivement posé qu'à l'étude histologique. Les tumeurs se répartissent en sarcomes phyllode dans 5 cas (41,7%), 4 cas de liposarcome (33,1%), 2 cas de fibrosarcome (16,7%), et un cas de dermatofibrosarcome (8,3%). Le bilan d'extension initial était négatif dans tous les 12 cas. Tous les patients avaient bénéficié d'une chirurgie dans leurs séquences thérapeutiques : tumorectomie dans 5 cas (41,67%) et mastectomie dans 7 cas (58,33%), dont trois avec en plus un curage axillaire homolatéral. Les limites d'exérèses étaient précisées dans seulement 3 cas et étaient envahies dans tous les cas. Une seule patiente avait reçu une radiothérapie adjuvante et 3 une chimiothérapie adjuvante dont une seule en pré et post opératoire. Quatre de nos patients ont présenté une récidive locale et dans tous les cas après une tumorectomie. Trois ont développé des métastases pulmonaires et sont décédées ; et une autre était décédée de cause inconnue. Quatre patients étaient perdus de vue après le diagnostic. Trois de nos patients sont en rémission complète avec des reculs de 5 ans, 3ans, et 1 an respectivement. Conclusion : les sarcomes mammaires sont rares, représentant environ 1% des cancers mammaires. Ils constituent un groupe à part de néoplasie mammaire, atteignant surtout les femmes jeunes en période d'activité génitale. La rareté de ces tumeurs et leur hétérogénéité histologique rendent difficile leur diagnostic ; compromettant ainsi leur prise en charge précoce d'où leur pronostic en général péjoratif

Plaies du tendon calcanéen par rayons de roue arrière de moto

Objectifs - Déterminer les aspects épidémiologiques et le mécanisme lésionnel, et évaluer les résultats du traitement des plaies du tendon calcanéen engendrées par les rayons de roue arrière de moto. Matériel et Méthodes - Il s'agissait d'une étude rétrospective concernant tous les patients traités pour une plaie du tendon calcanéen occasionnée par les rayons de roue arrière de moto entre Janvier 2014 et Décembre 2016. Résultats - Durant la période d'étude, trente-quatre patients totalisant 34 lésions ont été recensés. Il y avait (n=20; 59%) hommes et (n=14; 41%) femmes. L'âge moyen était de 12 ans (4 et 37 ans). Les élèves étaient les plus concernés (n=18; 53%). La section du tendon était totale (n= 22;65%) et partielle dans (n=12 ; 35%). Les lésions associées prédominantes étaient les fractures du calcanéum (n=14). Les complications postopératoires étaient infectieuses (n=14 ; 41%). La cicatrice était disgracieuse (n=10 ;29%). Au recul moyen de 17 mois, le résultat fonctionnel évalué selon le score de Mc Comis était excellent (n=16; 47%), bon (n=10 ; 29%), moyen (n=5 ;15%), et mauvais (n= 3;9%). Conclusion - Les plaies du tendon calcanéen par rayons de roue arrière de moto sont fréquentes. Elles ont concerné les enfants d'âge scolaire. La réparation définitive par suture en urgence est possible pour les plaies vues tôt. Les suites opératoires immédiates peuvent être émaillées de complications infectieuses. Mais l'évolution à moyen terme est favorable

Pattern of presentation and management of urolithiasis at federal medical centre, Nguru, Nigeria

Background: Urolithiasis has been with mankind since ancient time. Although it is more common in the developed world, the pattern of presentation in the developing countries is tending towards that of developed countries. Objectives: To evaluate the pattern of presentations and treatments offered to patients with urolithiasis over the last 2 years at Federal Medical Centre (FMC), Nguru.Materials and Methods: The study is a 2-year retrospective review of patients managed for urolithiasis at FMC Nguru. The patients' bio-data, pattern of presentation and radiological features of the stones, as well as the treatment given to the patients, were reviewed.Results: The records of 55 patients were reviewed; the mean age was 24.1 years with a range of 1.5 to 70years. The male to female ratio was 10:1. The most common presenting symptom was painful micturition in 21 patients (38.18%). The total number of stones extracted was 58, one patient had multiple right renal pelvic calculi, another had bilateral renal pelvic stone and the third patient had bladder and distal ureteric stone. Two patients (3.64%) expelled their calculi while awaiting surgery, the remaining 53 patients (96.36%) had opened surgical treatment. Most of the stones are in the bladder in 29 patients (52%). Twenty-one patients (38.18%) had upper urinary tract stones out of which 13 were in the renal pelvis.Conclusion: Urolithiasis is also common in the developing communities. Despite the changing pattern from lower to the upper tract in developed countries, we found lower tract stone dominating as seen in many underdeveloped. This may be attributable to yet to establish environmental or genetic factors

Admission patterns and outcomes in the medical intensive care unit of St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia

Background: Knowledge of the characteristics and outcomes of critically ill patients admitted to Medical Intensive Care Unit (MICU) helps with identification of priorities and the resources required to improve care. The objective of this study was to examine admission patterns and outcomes in MICU at St. Paul's Hospital Millennium Medical College. Materials: A retrospective review of 1256 patients' case notes who were admitted to the MICU at St. Paul's Hospital Millennium Medical College from 2007 to 2012 was carried out. The data was analyzed by SPSS version 18.0 to obtain descriptive and inferential measurements. P values < 0.05 were considered significant for all tests. Results: Among specific diagnoses, diabetic ketoacidosis; 187 (14.9%), was the leading cause of admission, followed by all Strokes; 103 (8.2%), and Unspecified Diseases of Circulatory System; 81 (6.4%). The overall mortality rate was 39 %. Strokes were the leading causes of death, accounting for 12.2% of total deaths. The deceased were older than the survivors by five mean age years, mean age (±SD) 41.9 (± 18.5) and 36.7 (± 17.4) years, respectively.Conclusions: Non- communicable will continue to be increasing proportion of ICU admissions in the study. The mortality in this study is also substantial, and reasons looks like late admissions and limited care in the facility. Improving the ICU infrastructure and staffing with skilled personnel might improve the quality of care

La rachianesthésie pour césarienne d'urgence en cas de prééclampsie sévère : une étude rétrospective de 44 cas

But. L'étude avait pour objectif d'étudier les modalités et le retentissement hémodynamique de la rachianesthésie pour césarienne en urgence dans un pays d'Afrique subsaharienne. Patients et méthodes. Il s'agit d'une étude rétrospective menée à Dakar durang un an, du 1er Janvier 2007 au 31 Décembre 2007 à partir des dossiers anesthésiques. Ont été recrutées toutes les patientes ayant bénéficié d'une césarienne sous rachianesthésie en urgence pour une pré éclampsie sévère. Les variables étudiées étaient les caractéristiques démographiques des patientes, le traitement antihypertenseur, le volume du remplissage, le score d'Apgar, le poids de l'enfant et le retentissement hémodynamique de la rachianesthésie. La pression artérielle systolique, la pression artérielle diastolique et la pression artérielle moyenne étaient mesurées avant et au cours de la rachianesthésie qui était pratiquée par 10 mg de bupivacaïne hyperbare à 0,5% et 2,5 γ de sufentanyl. Résultats. Quarante quatre patientes sur 48 ont été retenues dans l'étude avec un âge moyen de 33± 6,3 ans, des extrêmes de 26 ans et 40 ans et un âge gestationnel moyen de 35± 2 semaines d'aménorrhée (SA) avec des extrêmes de 34 et 37 SA. Le poids moyen des enfants était de 2044± 700 g avec 1340 g et 2750 comme extrêmes, avec un score d'Apgar moyen de 8±1 et des extrêmes de 7 et 9. Dix neuf patientes avaient un traitement antihypertenseur. Le remplissage vasculaire moyen était de 1640 ± 540 ml de Ringer lactate avec des extrêmes de 1000 ml et 2000 ml. Seules trois patientes ont eu des épisodes d'hypotension transitoires. Conclusion. La rachianesthésie est encore réalisable au cours de la pré éclampsie. Le retentissement hémodynamique est faible et sans conséquence pour la mère et l'enfant

Survival of patients with Kaposi's sarcoma in the South African antiretroviral treatment era: A retrospective cohort study

Background. When South Africa (SA) implemented its antiretroviral therapy (ART) programme in 2004, the model for treating HIV-positive Kaposi's sarcoma (KS) patients shifted from symptomatic palliation to potential cure.Objective. To evaluate survival and changes over time in AIDS-KS patients treated at a tertiary academic hospital oncology unit (the Steve Biko Academic Hospital medical oncology unit) in Pretoria, SA, in the context of ART availability in SA. Methods. We conducted a retrospective review of electronic and paper records of KS patients who accessed cancer care between May 2004 and September 2012. We used Kaplan-Meier survival functions to estimate 1- and 2-year survival, and Cox regression models to identify changes over time and prognostic factors.Results. Our study included 357 AIDS-KS patients, almost all of whom were black Africans (n=353, 98.9%); 224 (62.7%) were men. The median age at cancer diagnosis was 37 (interquartile range (IQR) 30 - 43) years, and the median baseline CD4+ count was 242 (IQR 130 - 403) cells/µL. Most patients received ART (n=332, 93.0%) before or after KS diagnosis; 169 (47.3%) were treated with chemotherapy and 209 (58.6%) with radiation therapy. Mortality was 62.7% lower (adjusted hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.19 - 0.73) in the late (2009 - 2012) than in the early (2004 - 2008) ART period. Receiving chemotherapy (adjusted HR 0.3, 95% CI 0.15 - 0.61) and poor-risk AIDS Clinical Trials Group KS stage (adjusted HR 2.88, 95% CI 1.36 - 6.09) predicted mortality.Conclusions. Our results show that large national ART roll-out programmes can successfully reduce KS-related mortality at the individual patient level. If ART coverage is extended, KS-associated morbidity and mortality are likely to drop

An investigation of diverticular disease among black patients undergoing colonoscopy at Dr George Mukhari Academic Hospital, Pretoria, South Africa

Background. Diverticular disease was previously thought to be non-existent in the black African population. Studies over the past four decades, however, have shown a steady increase in the prevalence of the disease.Objective. To report on the profile and current prevalence of diverticular disease in the black South African (SA) population at Dr George Mukhari Academic Hospital, Pretoria, SA.Methods. A retrospective descriptive study was performed in black SA patients who were diagnosed with diverticular disease by colonoscopy between 1 January and 31 December 2015.Results. Of 348 patients who had undergone colonoscopies and who were eligible for inclusion in this study, 47 were diagnosed with diverticular disease ­ a prevalence of 13.50% (95% confidence interval 10.30 - 17.50). The greatest number of patients diagnosed were in their 7th and 8th decades, with an age range of 46 - 86 (mean 67) years. There was a female predominance of 57.45%. Lower gastrointestinal bleeding was the most common (65.96%) indication for colonoscopy. The left colon was most commonly involved (72.34%), followed by the right colon (55.31%). A substantial number of patients had pancolonic involvement (27.65%).Conclusion. This retrospective study suggests that there has been a considerable increase in the prevalence of diverticular disease among black South Africans, possibly owing to changes in dietary habits and socioeconomic status