Fréquence et prise en charge des pseudarthroses traumatiques des os longs des membres à l'hôpital Matanda, en République Démocratique du Congo / Prevalence and risk factors for traumatic longbone pseudarthrosis at the Matanda Hospital, Butembo, eastern Democratic Republic of the Congo

Introduction : La pseudarthrose compte parmi les complications les plus redoutées des fractures et les plus difficiles à traiter. L'objectif de notre étude était de ressortir le profil épidémio-clinique des pseudarthroses à Matanda dans la région Nord-Est de la RDCongo. Méthodes : Notre étude était du type descriptif transversale ayant couvert une période allant du 01 Juin 2016 au 31 Mai 2019. Les données ont été tirées des dossiers d'hospitalisation. Le traitement des données a été réalisé par SPSS Statistics 17.0. Nous avons calculé la fréquence. Résultats : La fréquence des pseudarthroses a été de 3,72%, touchant surtout les femmes (83,3%), les adultes de 21-30ans (27,7%) et ceux de 61-70 ans 22,2%, les ruraux (69,4%), les cultivateurs (61,1%) et les moins instruits (50% niveau primaire et 36,1% niveau illettré). Le type de pseudarthrose le plus fréquent a été le type flottant (69,4%). Tous les cas de pseudarthrose ont été pris en charge par un Chirurgien orthopédiste, avec, dans la plupart des temps, une amélioration (77,7%). La complication la plus fréquente a été l'infection (19,4%) et l'issue défavorable la plus fréquente, l'amputation (11,1%). Conclusion. La pseudarthrose des os longs des membres demeure une complication fracturaire très invalidante à évolution imprévisible. La maitrise de sa chirurgie s'avère donc plus qu'urgente dans nos milieux.

Pharmaceutical situation of the pharmacological treatment of hospitalized patients with COVID-19 in Libya

By January 2020, severe acute respiratory syndrome coronavirus-2 has spread internationally to a pandemic that mainly targets the respiratory system. The relevant infectious disease has been identified as coronavirus disease-2019 (COVID-19) by World Health Organization and declared as a global pandemic. In Libya, National Center for Disease Control reported the first case of coronavirus disease-2019 on 24th March, 2020. The authorities decided to close borders and activate designated treatment centers to deal with COVID19 cases and contain the outbreak of SARS-COV-2. This study aimed to assess and evaluate the pharmaceutical situation of medications used in pharmacological management of hospitalized COVID-19 patients in Tripoli, Libya. Three WHO availability indicators were selected to be studied and reported. A comprehensive list of medicines used in the management of hospitalized COVID-19 patients was constructed after reviewing and comparing seven national and international pharmacological management protocols and guidelines for hospitalized COVID-19 patients. This comparison revealed that nearly 50 medications are intended for use in COVID-19 inpatient pharmacological management. They all agreed about the use of three medications, representing one from each main class. This list was used to cross check their availability at the chosen designated COVID-19 treatment center. This study proved that local treatment center's protocol is more in line with international guidelines than the national treatment guideline. The later was issued on March 2020. The Libyan National Essential Medicines' List contained 25 out of 50 medications of the comprehensive list based on the last update in April 2019. This study recommends that national treatment guidelines and National Essential Medicines' list require updating. Not all medications used in COVID-19 inpatient management were available in local treatment centers, although, the Emergency Management Department of Ministry of Health in Libya is responsible for the supply of the required medical supplies and medications to the COVID-19 treatment centers.

Mise en place d'un centre de traitement des épidémies (CTE) pour COVID-19 dans un service de Médecine Interne; les leçons apprises / Establishment of an Outbreak Center for Covid-19 (OCC), in an Internal Medicine department

Introduction: La fulgurante progression de la pandémie à covid -19 a imposé au Sénégal l'adoption de stratégies de riposte parmi lesquelles la mise en place de centres de traitement des épidémies (CTE) au sein des hôpitaux . Nous nous proposons d'évaluer les activités d'un CTE Covid-19 implanté dans un service de médecine interne et les leçons tirées de ce vécu. Méthodologie : Le CTE Covid -19 a été installé dans le service de médecine interne de l'Hôpital Régional de Thiès (HRT), mais avec conservation de lits dédiés aux patients non atteints de Covid-19. Les étudiants en année de doctorat affectés dans le service de médecine interne étaient responsables de la gestion quotidienne du CTE sous la supervision des spécialistes en médecine interne Ce service était subdivisé en deux parties: le CTE qui prenait en charge les cas de Covid -19 et le reste du service qui devait continuer à accueillir les patients atteints d'autres affections ou qui y étaient régulièrement suivies. Résultats : Du 1er mai au 30 octobre 2020, 237 patients ont été admis dans le CTE. Ils étaient âgés de 7 à 88 ans avec une moyenne d'âge de 53,41 ans et un sexe ratio de 1,60. Les motifs d'admission étaient une désaturation en oxygène inférieure à 90%, la présence d'au moins une comorbidité (autres infections, diabète , hypertension artérielle , obésité, maladies auto-immunes, cancers…). L'âge avancé mais aussi les patients ne pouvant être à domicile faisaient également partie des critères d'admission . Trois (3) cas de co-infection Covid-19 et tuberculose pulmonaire ont été relevés et trois (3) patients avaient un portage chronique du virus de l'hépatite B. Dans le cadre des hospitalisations non Covid -19, les affections suivantes ont été retrouvées : 8 cas de diabète déséquilibrés et autant d'hépatopathie (6,10%); l'accès palustre dans 3, 05% (n=3) ; la tuberculose pulmonaire (3,81%, n=3) ; 3 cas (2,29 %) d'anémie de type biermerien et de lupus érythémateux systémique. De même, 1 cas (0,76%) d 'empyème cérébral ; une polyarthrite rhumatoïde (0,76 %), une (01) maladie rénale chronique , 1 cas de défaillance cardiaque ont également été enregistrées. Cinq (5) cas (3,81 %) non affectés par l'infection à Covid -19 , à leur admission l'ont été au cours de leur hospitalisation et donc transférés au niveau de la zone rouge du CTE. Conclusion: La mise en place du CTE au niveau du service de Médecine interne , a permis une adaptation efficiente dans la prise en charge des patients concernés mais aussi de ceux qui étaient suivis pour des pathologies chroniques comme les urgences médicales reçues durant la période. La continuité des soins a été assurée et les liens avec les autres secteurs de la pyramide sanitaire du Sénégal ont été raffermis.

Introduction : The fast progression of covid -19 throughout the world has forced Senegal to adopt response strategies including the establishment of Outbreak Center for Covid- 19 (OCC ) within hospitals . We propose to evaluate the activi ties of an OCC implemented in an internal medicine department and the lessons learned from this experience. Methodology: The center for care of Covid-19 has been installed in the Internal Medicine department of the Thies Regional Hospital (HRT ), but with dedicated beds for patients non affected by the pandemic . Fifteen doctoral students were assigned, by local medical school , to the Department of Internal Medicine in order to be responsible for the day-to-day management of the OCC. They were supervised by internal medicine specialists . This service was divided into two parts: the OCC that handled Covid -19 cases and the rest of the service , which was to continue to take care of patients with other conditions or who were regularly monitored. Results: From May 1 to October 30, 2020, 237 patients were admitted to the CTE They ranged from 7 to 88 years old with an average age of 53.41 and a sex ratio of 1.60 .The reasons for admission were an oxygen desaturation of less than 90%, the presence of at least one comorbidity (other infections, diabetes, arterial hypertension, obesity, autoimmune diseases, cancers, etc .). Advanced age but also patients who could not be at home were also part of the admission criteria. Three (3) cases of Covid -19 co -infection and pulmonary tuberculosis were identified and three (3) patients had a chronic carriage of the hepatitis B virus. In the context of non -Covid -19 hospitalizations, the following conditions have been found: 8 cases of unbalanced diabetes and as many hepatopathy (6.10%); malaria access in 3.05% (n = 3); pulmonary tuberculosis (3.81%, n = 3); 3 cases (2.29%) of biermeric type anemia and systemic lupus erythematosus. Similarly, 1 case (0.76 %) of cerebral empyema; rheumatoid arthritis (0.76%), one (01) chronic kidney disease, 1 case of heart failure were also recorded Five (5) cases (3.81%) not affected by Covid-19 infection, on admission, were during their hospitalization and therefore transferred to the red zone of the CTE. Conclusion : The establishment of the OCC in the internal medicine service allowed an efficient adaptation in the care of the patients affected by covid disease but also of those who were followed for chronic pathologies or admitted for other medical emergencies This strategy has improved and strengthened the links with other sectors of Senegal 's health pyramid.

Coping strategies of mothers with preterm babies admitted in a public hospital in Cape Town

Background: Most pregnancies run a normal course, ending in a healthy mother­infant relationship, but sometimes, it can also be a life-threatening and stressful condition. The stress levels of mothers are more aggravated when they deliver preterm babies.Objectives: To explore the coping strategies of mothers of preterm babies with the stress of preterm delivery and subsequent admission of the preterm neonate to a neonatal care unit.Method: A qualitative research approach applying an exploratory and descriptive design was applied to explore the coping strategies of mothers with preterm babies admitted in a neonatal care unit. The study applied a purposive sampling technique to select mothers with preterm babies. The population for this study included women who delivered preterm babies and whose babies were admitted in the neonatal care unit at a public hospital in Cape Town. Semi-structured interviews were conducted until data saturation was reached, and 11 mothers with preterm babies in the selected public hospital participated in the study. Data were analysed manually using thematic content analysis with an inductive approach. Results: Results were deductively interpreted and supported by the Brief COPE model. The main themes that emerged from data analysis included praying, attachment with baby and acceptance of the situation. Under praying the following subthemes emerged, namely praying for God's strength, God's grace, babies' survival and thanksgiving to God for babies' health and preferred gender. The theme of attachment with the baby emerged with the following subthemes: bonding with the baby and seeing the baby. The last theme that was acceptance of the situation emerged with the following subtheme: perseverance in the situation and mother's awareness of her responsibility. Conclusion: Even though the mothers of preterm babies cope differently after delivery, their coping abilities, which included praying, attachment to baby and acceptance of the situation, were greatly determined by the condition of their babies as well as the support they receive from significant others

A profile of adult acute admissions to Lentegeur psychiatric hospital, South Africa

Background: The Western Cape province has the highest documented lifetime prevalence of common mental disorders in South Africa. To ensure the efficient, equitable and effective distribution of current resources, there is a need to determine the profile of patients requiring psychiatric admission.Aim: To describe patients admitted to the acute adult admissions unit at Lentegeur Hospital.Setting: Lentegeur Psychiatric Hospital is situated in Mitchells Plain, Cape Town, and serves about 1 million people from nearby urban and rural areas.Methods: This retrospective study involved an audit of all patients (18­60 years of age) admitted between 01 January 2016 and 30 June 2016. The clinical records of 573 adult patients were examined.Results: The median age of the cohort was 29 years. Most patients (63%) were educated to the secondary level. Only 12% of the patients were employed, and 37% received disability grants. More than 90% of the patients presented with psychotic symptoms. Of these, 28% presented with a first-episode of psychosis. Of all patients, 20% were referred with manic symptoms and 7% with depressive symptoms. Many patients (62%) used substances concurrently in the period leading up to admission. Significantly more males (73%) used substances compared to females (38%). Cannabis was the most widely used substance (51%), followed by methamphetamine (36%). Recent violent behaviour contributed to 37% of the current admissions. A total of 70 patients (13%) tested positive for human immunodeficiency virus (HIV), and 49 (9%) tested positive for syphilis.Conclusion: Substance use and a history of violence contributed to admissions in this population

Hepatitis E virus in patients with acute hepatitis in Cape Town, South Africa, 2011

Background. Early hepatitis E virus (HEV) seroprevalence studies in South Africa (SA) showed seroprevalence rates of 2 - 10%, and suggested waterborne transmission. More recent studies in Cape Town, SA, reported HEV seroprevalence rates of 28% and 26% in outpatients without liver disease and blood donors, respectively. An association was found with eating pork or bacon/ham. Only 3 human cases of hepatitis E in SA have been reported in the literature. Objectives. To find evidence of HEV infection in hospitalised patients with acute hepatitis and no other identified cause. Methods. Leftover serum samples were retrieved for patients negative for hepatitis viruses A, B and C, where no other cause of hepatitis was identified. Samples were tested for HEV by polymerase chain reaction (PCR) and IgM and IgG enzyme-linked immunosorbent assay (ELISA). Results. Anti-HEV IgG was detected in 39/132 specimens (29.5%; 95% confidence interval (CI) 22.4 - 37.8), and anti-HEV IgM in 2/125 specimens (1.6%; 95% CI 0.4 - 5.7). No specimen tested positive by PCR. Conclusions. IgG seroprevalence found in this study was similar to that previously reported in Cape Town. IgM positivity in 2 patients was not confirmed by PCR. Locally, hepatitis E may not be a common cause of clinically apparent hepatitis that requires hospitalisation

The association between hospital arrival time, transport method, prehospital time intervals, and in-hospital mortality in trauma patients presenting to Khayelitsha Hospital, Cape Town

Introduction:Trauma is a leading cause of unnatural death and disability in South Africa. The aim of the study was to determine whether method of transport, hospital arrival time or prehospital transport time intervals were associated with in-hospital mortality among trauma patients presenting to Khayelitsha Hospital, a district-level hospital on the outskirts of Cape Town, South Africa.Methods:The Khayelitsha Hospital Emergency Centre database was retrospectively analysed for trauma-related patients presenting to the resuscitation area between 1 November 2014 and 30 April 2015. Missing data and additional variables were collected by means of a chart review. Eligible patients' folders were scrutinised for hospital arrival time, transport time intervals, transport method and in-hospital mortality. Descriptive statistics were presented for all variables. Categorical data were analysed using the Fisher's Exact test and Chi-square, continuous data by logistic regression and the Mann Whitney test. A confidence interval of 95% was used to describe variance and a p-value of <0.05 was deemed significant.Results:The majority of patients were 19­44 year old males (n = 427, 80.3%) and penetrating trauma the most frequent mechanism of injury (n = 343, 64.5%). In total, 258 (48.5%) patients arrived with their own transport, 254 (47.7%) by ambulance and 20 (3.8%) by the police service. The arrival of trauma patients peaked during the weekend, and was especially noticeable between midnight and six a.m. In-hospital mortality (n = 18, 3.4%) was not significantly affected by transport method (p = 0.26), hospital arrival time (p = 0.22) or prehospital transport time intervals (all p-values >0.09). Discussion:Method of transport, hospital arrival time and prehospital transport time intervals did not have a substantially measurable effect on in-hospital mortality. More studies with larger samples are suggested due to the small event rate

Serum levels of Selenium and C-reactive protein in comatose patients with severe traumatic brain injury during the first week of hospitalization: case-control study

Introduction: mortality and morbidity related to traumatic brain injuries still remain high in patients. Many authors reported the importance of Selenium in maintaining the integrity of brain functions. This fact is supported by clinical evidence that therapy with selenium supplementation could help patients suffering from brain disorders like neurodegenerative diseases. The aim of our study was to assess the relationship between Selenium concentration in serum and evolution of comatose patients with severe traumatic brain injury, in the first week of admission, and the correlation between selenium and C-reactive protein.Methods: this case-control study was conducted with 64 comatose patients with TBI, in the Department of Anesthesiology and Reanimation, IbnSina University Hospital and Hospital of specialties in Rabat-Morocco, and healthy volunteers recruited in Blood transfusion center of Rabat. Blood sampling was collected from TBI patients, in the first week (3h after admission and each 48h during one week), and from healthy volunteers one time. Concentration of Se in serum was determined by electrochemical atomic absorption spectrometry. Statistical analysis was performed using Statistical software (SPSS) and the cases and controls were compared using the Mann-Whitney U test. A P-value < 0.05 was considered to be statistically significant.Results: comparison selenium concentration in the first day (D0), third day (D2) and fifth day according to the death and survival statue in patients did not show statistical significance (p > 0.05). Selenium concentration of D0 in patients and Selenium concentration in control group also did not show statistical significance (p > 0.05). Similarly, we did not report a correlation between selenium and C-reactive protein.Conclusion: according to our data selenium and CRP may not play a role in progression of coma state in patients with severe traumatic brain injury

Pneumococcal conjugate vaccines and hospitalization of children for pneumonia: a time-series analysis, South Africa, 2006­2014

Objective To assess the impact of immunization with pneumococcal conjugate vaccines on all-cause pneumonia hospitalizations among children in Soweto, South Africa. Methods We used data collected at the Chris Hani Baragwanath Hospital in Soweto between 2006 and 2014 ­ i.e. before and after April 2009, when a pneumococcal conjugate vaccine was first included in South Africa's routine immunization programme. Using a Bayesian generalized seasonal autoregressive moving-average model and the data collected in 2006­2008, we estimated the numbers of children that would have been hospitalized for pneumonia between 2010 and 2014 if no pneumococcal conjugate vaccines had been used. These estimates were then compared with the corresponding numbers of hospitalizations observed. Findings Between 2006 and 2014, 26 778 children younger than five years ­ including 3388 known to be infected with human immunodeficiency virus (HIV) ­ were admitted to the study hospital for pneumonia. We estimated that, for the children known to be infected with HIV and for the other children, pneumococcal conjugate vaccines reduced the numbers of hospitalizations for pneumonia in 2014 by 33% (50% credible interval, CrI: 6 to 52) and 39% (50% CrI: 24 to 50), respectively. In the study hospital in 2012­2014, as a result of immunizations with these vaccines, there were an estimated 3100 fewer pneumonia hospitalizations of children younger than five years. Conclusion. In our study hospital, following the introduction of pneumococcal conjugate vaccines into the national immunization programme, there were significant reductions in pneumonia hospitalizations among children

Deep-vein thrombosis in the era of high HIV and tuberculosis prevalence: A prospective review of its diagnosis and treatment in a quaternary centre

Background. Venous thromboembolic disease (VTE) is a leading cause of morbidity and mortality worldwide. HIV and tuberculosis (TB) infections have an aetiological association with VTE. Implementation of national HIV and TB programmes in South Africa (SA) has changed the burden of these two conditions, with resultant effects on VTE prevalence. Furthermore, with the increased use of direct oral anticoagulants (DOACs), baseline thrombosis data are needed to evaluate the effect of these new agents.Objectives. To determine real-life baseline VTE characteristics in a pre-DOAC era, and to document the association of HIV and TB infections with VTE.Methods. This was a single-centre prospective cohort study performed in a quaternary care centre at Charlotte Maxeke Johannesburg Academic Hospital, SA. Key inclusion criteria included signed informed consent by adults (≥18 years) with a new episode of thrombosis. Procedures included physical examination, thrombosis risk factor assessment, duplex Doppler examination, thrombophilia screening, inpatient treatment and outpatient follow-up.Results. Ninety-nine participants with confirmed thrombosis met the inclusion criteria. Participants were predominantly black (79.8%) and female (64.6%), with a median age of 46 (interquartile range (IQR) 38 - 57) years. The prevalences of HIV and TB were 53.0% and 21.2%, respectively. The most common risk factors for thrombosis were TB (17.2%) and malignancies (14.1%). Thrombophilia screening had a low diagnostic yield. The median time to target international normalised ratio during hospitalisation was 5.5 (IQR 4.0 - 7.0) days and the median duration of hospitalisation was 9 (IQR 7 - 11) days. The overall mortality rate in the cohort at 3 months post hospitalisation was 12.1%.Conclusions. This prospective study provides real-life data on thrombosis diagnosis and management at a quaternary public healthcare facility, providing a valuable baseline against which the effect of new DOAC anticoagulants can be assessed. Further research is required to clarify the aetiological association between thrombosis and HIV and TB

Les motifs d'hospitalisation chez les enfants de moins de 16 ans à Bamako

Introduction : Les maladies de peau constituent un motif fréquent de visite dans les centres de santé au Mali où elles représentent 10% des consultations. Le but de ce travail était de décrire les motifs d'hospitalisation chez les enfants de moins de 16 ans à Bamako.Matériel et méthodes : Du 1er janvier 2010 au 31 Décembre 2014, nous avons mené une étude transversale dans le service dermatologie du CNAM. Les patients âgés de moins de 16 ans hospitalisés ont été inclus et les dossiers correspondant ont été revus.Résultats : Au total sur 398 patients hospitalisés durant la période d'étude, 69 enfants de moins de 16 ans ont été recensés, soit une proportion de 17,34%. Parmi ces enfants hospitalisés, seuls 50 dont les dossiers étaient complets ont été inclus. L'âge des malades variait entre 1 et 15 ans avec une moyenne d'âge de 11,9±0,58 ans. Les principaux motifs d'hospitalisation étaient les dermatoses infectieuses (29 cas/58%), les toxidermies (7 cas/14%), les dermatoses bulleuses auto-immunes (5cas/10%), l'eczéma érythrodermique (2 cas/4%), les ulcères drépanocytaires (3 cas/6%), la dermatomyosite (3 cas/6%), l'épidermolyse bulleuse congénitale (1 cas/2%) et l'ecthyma gangreneux (1 cas/2%). Nous avons enregistré 3 cas de décès suite à une dermatomyosite sévère, d'une fasciite nécrosante et d'un syndrome de Lyell.Conclusion : Cette étude a monté la fréquence élevée des dermatoses bactériennes dominées par les dermo-hypodermites. Elle nous a également permis de confirmer l'effet aggravant des AINS et des médicaments de la pharmacopée traditionnelle sur les dermo-hypodermites

What factors influence the average length of stay among stroke patients in a Nigerian tertiary hospital?

Introduction: Increased emphasis is being laid on ensuring that health resources are efficiently utilized, especially in resource-constrained settings such as in Nigeria. One of the main indices of how efficiently a health institution is being run is Length of Stay (LOS), which is likely to be higher in chronic diseases such as stroke and diabetes. Stroke is a chronic disease that is currently on the rise in Low and Middle income countries (LMICs) who are also characterized by constraint of health resources. This study seeks to determine the LOS of stroke patients as well as factors that affect it.Methods: A retrospective analysis of health records of stroke victims admitted into the medical wards of the University College Hospital, Ibadan between January 2012 and December 2014 was conducted. Data on sociodemographic information, comorbidities and risk factors were extracted while LOS was calculated by counting the number of days the patient was admitted. Analysis was carried to using SPSS.Results: A total of 143 records were used in the final analysis with 53.1% of them being males and having a mean age of 61.5 ± 14.2 years. More than half (53.8%) of the cases were ischemic strokes. The average length of stay was 13.7 ± 8.9 days while bivariate analysis showed that a greater proportion of cases who consumed alcohol, had diabetes and hypertension had LOS of over 7 days than those who did not. However, these differences in proportions were not statistically significant (0.310<p<0.883).Conclusion: LOS of stroke patients in Nigeria was shown to be prolonged especially when compared to similar settings in West Africa. The high prevalence of some of the risk factors of stroke such as diabetes mellitus indicates that policy and advocacy to drive changes in lifestyle are necessary to reduce the incidence of stroke and its consequent burden on health systems

Profil épidémiologique des pathologies respiratoires chez l'enfant à l'Hôpital d'Enfants de Rabat, Maroc

Introduction: les pathologies respiratoires représentent un motif fréquent d'hospitalisation en pédiatrie. L'objectif de cette étude était d'évaluer le profil épidémiologique des pathologies respiratoires chez l'enfant à l'hôpital d'enfants de Rabat, Maroc.Méthodes: il s'agit d'une étude observationnelle transversale qui a concerné tous les cas d'enfants âgés de 3 mois à 15 ans hospitalisés pour une pathologie respiratoire au service de pneumoallergologie et infectiologie pédiatriques de l'hôpital d'enfants de Rabat sur une période d'une année, du 1 janvier 2014 au 31 décembre 2014.Résultats: sur 3537 patients hospitalisés, 2493 (70,5%) l'ont été pour une pathologie respiratoire. Les hospitalisations pour exacerbation d'asthme (p < 0,001), bronchiolite aigüe (p < 0,001) et dyspnée laryngée (p = 0,004) étaient plus fréquentes chez le garçon alors que les hospitalisations pour pneumopathie aigüe (p = 0,005), pour inhalation de corps étranger (p = 0,007) et pour coqueluche (p = 0,020) étaient plus fréquentes chez la fille. Les hospitalisations pour pneumopathie aigüe (p < 0,001), exacerbation de séquelles graves de virose (p < 0,001) et pour coqueluche (p < 0,001) étaient plus fréquentes chez le nourrisson. Les hospitalisations pour pneumopathie aigüe (p < 0,001) et pour coqueluche (p = 0,015) étaient plus fréquentes en période automnohivernale.Conclusion: les motifs d'hospitalisation étaient dominés par les exacerbations d'asthme et la bronchiolite aigüe, lesquelles étaient plus fréquentes chez le garçon. Les infections respiratoires, représentées par les pneumopathies aigües et la coqueluche, étaient plus fréquentes en période automnohivernale et touchaient plus le nourrisson

Compressions médullaires lentes : prévalence et étiologies, expérience du service de rhumatologie du CHU de Cocody à Abidjan

Objectif : Déterminer la prévalence du syndrome de compression médullaire lente et en identifier les étiologies en pratique rhumatologique à Abidjan.Patients et méthodes : Notre étude rétrospective et descriptive, a été menée au sein du service de rhumatologie du CHU de Cocody à Abidjan de Janvier 2004 à Décembre 2013. Nous avons sélectionné 121 patients souffrant de syndrome de compression médullaire clinique. Nous nous sommes intéressés aux données sociodémographiques et étiologiques.Résultats : La prévalence hospitalière était de 2,6% soit 121 patients sur 4531 pathologies rhumatologiques. Les hommes prédominaient (56,1%) avec un sex-ratio de 1,3. L'âge moyen était de 48,8 ans. Les patients se plaignaient d'un déficit moteur isolé (42,2%) ou associé à une cervicalgie (16,5%), à une dorsalgie (23,1%) et à une dorsolombalgie (18,2%). La durée moyenne d'évolution du syndrome de compression médullaire était de 1,2 mois. Les principaux signes cliniques étaient une parésie ou paralysie (98,3%) et une radiculalgie (93,4%). La tomodensitométrie constituait l'imagerie majeure (80,1%). Les étiologies étaient les spondylodiscites bactériennes (55,3%) dominées par le mal de Pott (52% des cas), les affections rachidiennes dégénératives (23,3% des cas) et les causes tumorales malignes (21,4%).Conclusion : Le syndrome de compression médullaire lente est rare en pratique rhumatologique à Abidjan. Les étiologies sont dominées par les spondylodiscites bactériennes principalement le mal de Pott

Outcome of tube thoracostomy in paediatric non-traumatic pleural fluid collections

Objective: Management of pleural fluid collection not due to trauma increases workload of the paediatric thoracic surgeons; while delay or inappropriate treatment worsens the prognosis of the disease. This study aimed at assessing the outcome of therapeutic tube thoracostomy in non-traumatic paediatric pleural fluid collections and identifying factors responsible for treatment failure with tube thoracostomy. Design: Prospective analysis of socio-demographic characteristics; clinical features; clinical diagnosis; radiological diagnosis; and bacteriological diagnosis including bacteria cultured with sensitivity pattern; also treatment offered including tube thoracostomy with duration of tube thoracostomy and length of hospitalisation; indication for additional surgical procedure with type; and outcome of treatment of 30 paediatric patients with non-traumatic pleural fluid collection. Results: Thirty paediatric patients with various causes of non-traumatic pleural fluid collection in 34 pleural spaces were analysed. Their ages ranged between six months and 16 years (mean = 6.5 years) and M:F ratio of 2:1. Pleural effusion and empyema thoracis accounted for 46 and 40 with staphylococcus aureus and streptococcus pneumoniae cultured in 10 each and a high negative culture rate of 46; which was higher with age. The parents of 40 of the patients belonged to social class 3. Success rate of tube thoracostomy was 86 in unilateral cases; 50 in bilateral cases and 81 in all cases. Alternative treatment with thoracotomy and decortications gave a success rate of 100. Conclusion: Thoracotomy with decortication is superior to tube thoracostomy in paediatric non-traumatic pleural fluid collection and should be chosen as the primary treatment option when there is bilateral disease; chronicity; loculated effusion; thickened pleural membranes or trapped lung

Traumatic brain injuries in children: a hospital-based study in Nigeria

The most frequent computed tomography finding was intracerebral haemorrhage. Mean duration of hospitalization was 18 days (median 11 days). Eleven patients died; mortality correlating well with severity and the presence of intracerebral haematoma. Conclusion: Head injuries in children are due to motor vehicle and motor vehicle-related accidents. Hence; rational priorities for prevention of head injuries in children should include prevention of vehicular; especially pedestrian; accidents in developing countries.Background: Traumatic Brain Injury (TBI) is a significant cause of morbidity and mortality worldwide. Our previous studies showed a high frequency of motor vehicle accidents among neurosurgical patients. However; there is a dearth of data on head injuries in children in Nigeria. Aims: To determine the epidemiology of paediatric traumatic brain injuries. Setting and Design: This is a prospective analysis of paediatric head trauma at the University of Benin Teaching Hospital; a major referral centre for all traumatic brain injuries in Nigeria between October 2006 and September 2011. Materials and Methods: We studied the demographic; clinical and radiological data and treatment outcomes. Data was analysed using statistical package for the social sciences (SPSS) 16.0. Results: We managed 127 cases of paediatric head injuries; 65 boys and 62 girls representing 13 of all head injuries managed over the 5-year period. They were aged 3 months to 17 years. The mean age was 7.4 years (median 7 years) with peak incidence occurring at 6-8 years i.e. 31 (24.4) cases. Motor vehicle accidents resulted in 67.7; falls 14 and violence 7

Evaluation of a Project to Reduce Morbidity and Mortality from Traditional Male Circumcision in Umlamli; Eastern Cape; South Africa: Outcome Mapping

Background: Traditional circumcision is common among the amaXhosa in Umlamli; Eastern Cape. Circumcision is associated with high morbidity and mortality. The need to reduce complications was identified as a priority by the local community. The aim was to design; implement and evaluate a project to improve the safety of traditional circumcision.Method: A safe circumcision team was established and comprised health workers; community leaders and traditional surgeons. Outcome mapping involved three stages: intentional design; outcome; and performance monitoring and evaluation. The eight boundary partners were the initiates; parents; community leaders; traditional surgeons; the District Health Services; the provincial Department of Health; the emergency services and the police. Outcomes; progress markers and strategies were designed for each boundary partner. The team kept an outcome and strategy journal and evaluated hospital admissions; genital amputations and mortality.Results: Ninety-two initiates were circumcised; with two admissions for minor complications; compared to 10 admissions; two amputations and two deaths previously. More than 70 of the outcome measures were achieved in all boundary partners; except emergency services and the Department of Health. The key aspects were: the use of outcome mapping; the participatory process; a lower age limit; closure of illegal schools; consolidation of accredited schools; training workshops for traditional surgeons; private treatment room for initiates; assistance with medical materials; pre-circumcision examination; certificates of fitness.Conclusion: This study has shown the value of community-orientated primary care initiatives to address local health problems. Key lessons were identified and the project could easily be replicated in communities facing similar challenges

Attitudes and experiences of women admitted to hospital with abortion complications in Ghana

Unsafe abortion is one of the major contributors to high levels of maternal mortality in Ghana, despite a relatively liberal legal environment. This paper presents findings from a semi-structured hospital-based survey of 131 Ghanaian women who had experienced unsafe abortion. The majority of respondents were young and single, with no children or just one child. Most had middle-school education or higher and were employed, as were their partners. While knowledge of family planning was high, knowledge of specific methods was barely moderate and only 17% respondents had ever used it ­ much lower than the national everuse of 39%. There were widespread misunderstandings about who could use family planning and 41% said they were afraid of sideeffects. Eleven percent said their pregnancy was planned and 31% that they wanted their pregnancy but were pressured by partners or families to abort. Overall, about one-third of respondents said they aborted because they were not married and two-thirds said they aborted because of socio-cultural pressures. This study highlights clear ongoing failings of the family planning programme which needs to be revamped, as well as an urgent need for improving public knowledge about access to safe, legal abortion services (Afr J Reprod Health 2011; 15[1]: 47-55)

A Profile on and Medical Conditions of Patients Staying Longer Than the Set Norm at a District Hospital in South Africa

The average length of hospital stay is regarded as a key determinant of greater hospital costs. The objectives of this quantitative; retrospective; descriptive study were to determine the health status and medical conditions of patients with increased length of stay at a district hospital in Limpopo Province. A total of 609 patients' records with longer than average length of stay; from January to December 2007; were selected by stratified random sampling. The most prevalent diseases for staying longer were infectious and parasitic diseases; symptoms; signs etc; and injury; poisoning and consequences of causes yielding more than a third (36 and 12; respectively; for each classification). Neoplasm-related admissions; in which cancer was identified as the most prevalent; stayed in hospital for an average of 14.6 days. The average length of stay for all disease classifications ranged from 7.1 days to 14.6 days. The length of stay at Elim Hospital is mostly influenced by the type of health conditions which are diagnosed. Further research is needed to find influential factors that might contribute to patients staying longer than normal