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

Turnaround time for electrolytes, urea, and creatinine in a clinical laboratory

Background: Timeliness is expressed as the turnaround time and is often used by the clinician as a benchmark for laboratory performance.Clinicians depend on fast turnaround time to achieve early diagnosis and treatment of their patients and early patient discharge from departments or hospital in-patient services. Determination of the turnaround time would enable a critical self- appraisal of our laboratory services and improve our turnaround time. Objective: This study assessed the turnaround time for electrolytes, urea and creatinine tests from the emergency departments of the hospital. Materials and Methods: An observational study was conducted between September and October 2016 amongst patients from the Intensive Care Unit, Accident and Emergency Department and Children Emergency Room, whose blood specimens were received at the Chemical Pathology Department foremergencyelectrolytes, urea and creatinine tests. A total of 122 specimens were randomly selected and the average time taken to complete each phase was measuredand the overall turnaround time calculated. Data was analysed using statistics software SPSS (version 13.5). Results: Audited cases consisted of 20 (16.4%) specimens from the Intensive Care Unit, 40 (32.8%) from the Children Emergency Room and 62 (50.8%) from the Accident and Emergency Department. The average turnaround time for the Accident and Emergency Department, Intensive Care Unit, and Children Emergency room were 6.5hours, 4.2hours and 5.2hours respectively. Conclusion: This study revealed that the turnaround time for electrolytes, urea and creatinine for patients in the emergency units is quite long and requires some improvement which could be done with the use of Laboratory Information System to track specimens from the various emergency units of the hospital

Lifetime mental disorders and suicidal behaviour in South Africa

There is relatively little data on the relationship between lifetime mental disorders and suicidal behaviour in low and middle income countries. This study examines the relationship between lifetime mental disorders; and subsequent suicide ideation; plans; and suicide attempts in South Africa. Method: A national survey of 4185 South African adults was conducted using the World Health Organization Composite International Diagnostic Interview (CIDI) to generate psychiatric diagnoses and suicidal behaviour. Bivariate; multivariate and discrete-time survival analyses were employed to investigate the associations between mental disorders and subsequent suicide ideation; plans; and attempts. Results: Sixty-one percent of people who seriously considered killing themselves at some point in their lifetime reported having a prior DSM-IV disorder. Mental disorders predict the onset of suicidal ideation; but have weaker effects in predicting suicide plans or attempts. After controlling for comorbid mental disorders; PTSD was the strongest predictor of suicidal ideation and attempts. There is a relationship between number of mental disorders and suicidal behaviour; with comorbidity having significantly sub-additive effects. Conclusion: Consistent with data from the developed world; mental disorders are strong predictors of suicidal behaviour; and these associations are more often explained by the prediction of ideation; rather than the prediction of attempts amongst ideators. This suggests some universality of the relevant mechanisms underlying the genesis of suicidal thoughts; and the progression to suicide attempts

Rapid Identification and Susceptibility Testing of Gram-Negative Bacilli from Blood Cultures Using the Vitek 2 System

Providing rapid results for blood culture isolates is a critical function of clinical microbiology laboratories. This study evaluated the accuracy and turnaround time for identification and susceptibility testing of Gram-negative bacilli inoculated directly from positive blood cultures into the Vitekr 2 system. Direct inoculation was compared to conventional methods; which included biochemical tests; commercial identification systems and disc diffusion susceptibility testing. Two hundred and ninety-one of 327 isolates (89) were correctly identified to at least genus level by the direct Vitekr method. Susceptibility test results were compared for 3;925 organism antibiotic combinations. The overall rate of categorical agreement of direct and conventional antimicrobial susceptibility testing was 92with less than 3very major and major errors combined. The mean turnaround time for identification and susceptibility testing was 7.5 hours (SD 3.0 hours) compared to a mean of 32.3 hours (SD 14.7 hours) for the conventional method. These results suggest that direct inoculation of the Vitekr 2 system from blood cultures provides accurate; reliable identification and antimicrobial susceptibility results for the majority of commonly occurring Gram-negative pathogens; while the significantly reduced turnaround time should benefit patients and permit earlier rationalisation of antibiotic therapy; with a reduction in the use of broad spectrum antibiotics. A suggested protocol for routine use is included

Timing of Spontaneous Birth and the Risk of Adverse Perinatal Outcome

Abstract:The study aspired to assess the impact of time of birth on spontaneous onset of labour and delivery. A retrospective descriptive study was conducted from the Empangeni Hospital delivery registry on 9;397 infant births between January to December 2005; weighing more than 1;000 g. Logistic regression; adjusting for birth weight and for gender was used to estimate the relationship between spontaneous birth and timing of birth. A higher proportion of births (59) occurred between 10h00 and 22h00 of the day. Estimating the hourly births; we found that the daytime peak is 5.3 and occurred at 10h00 while the night-time peak is 4.9 and occurred at 20h00. Maternal age was significantly associated with the timing of spontaneous births (p 0.05). A higher proportion of preterm babies was born during the day (6.4) and early night (3.4) compared to late night births (1.6). There were significant differences between multiple births and low birth weight infants born during the day (1.1; 6.9) and night (0.8; 6.3). However; low birth weight babies were born mostly during early night rather than late night (4 vs. 2.3; p 0.05). Adverse pregnancy outcome; measured by estimating the perinatal mortality rate; was the same for day and night and was equally distributed between early and late night. Timing of birth of infants did not influence the negative outcomes of pregnancy among this study population

Relationship between duration of diagnosis and neuromusculoskeletal complications of middle-aged type 2 diabetes patients

Abstract. BACKGROUND: Patients with Type 2 Diabetes (T2D) often present with complications involving the neuromusculoskeletal system which creep in as the condition advances in years. Hence there is a need to further understand how the duration of diagnosis of diabetes (DD) relates to the neuromusculoskeletal complications in order to design timely preventive programmes. OBJECTIVE: To investigate the relationship between the duration of diabetes and neuromusculoskeletal complications in type 2 diabetes. METHODS: This was a cross-sectional survey involving 139 consenting T2D patients and 139 age and sex-matched nondiabetic individuals. The participants were assessed for the DD and selected neuromusculoskeletal complications including muscle weakness, ranges of motion (ROM), pain and foot ulceration. RESULTS: The mean DD was 7.82 ± 2.41 years. There were significant differences (p < 0.01) between the clinical variables of both groups. In the diabetic participants, significant inverse relationships (P<0.05) were obtained between the DDD and each of muscle strength {elbow flexors (r = -0.57), knee extensors (r = -0.63), handgrip (r = ­0.82)}; ROM {wrist extension (r = -0.64) and ankle planterflexion (r = -0.63)}. Significant and direct relationships were obtained between the DDD and each of pain (r = 0.62) and ulcerative grading (r = 0.81). CONCLUSIONS: Type 2 Diabetes patients have poorer neuromusculoskeletal variables and longer duration of diabetes is associated with reduced muscle strength, diminished ROM, gradual ulceration of skin of the feet and higher level of foot pain. Immediate therapeutic exercises against these complications soon after diagnosis of diabetes may help to decelerate their progression