Emergency centre patients in the Democratic Republic of Congo: Some epidemiological and clinical aspects at Beni General Referral Hospital

Introduction: Little information is available regarding the characteristics of patients attending the emergency centre (EC) in the Democratic Republic of Congo. This study aims to provide some epidemiological and clinical aspects of patients admitted to the emergency centre at Beni General Referral Hospital. Methodology: For a year, from January to December 2021, a cross-sectional study was conducted. Data regarding patients' characteristics, admission modality, stay duration, reason for admission, and discharge modality was anonymously collected from patients' registers. A descriptive analysis was done with Epi-Info 7. Result: A total of 1404 patients were admitted to the EC, with a male-to-female ratio of 1.2 to 1. The age group below 18 years accounted for 35.4%. Most of the patients (75.7%) originated from urban areas. In 83% of cases, there was no recommendation from another medical facility for EC admission. The most common reasons for admission are non-traumatic gathering on top of neuropsychiatric and non-specific symptoms. Road traffic accidents are the most frequent causes of trauma symptoms. Few patients (14.7%) spent less than 12 hours in the EC. Globally, 7.3% of patients admitted to the EC were discharged after being managed, and 89% were transferred to different wards. The intra-emergency centre mortality rate was 11.8% among admitted patients in the ER at Beni General Referral Hospital. Conclusion: This epidemiology database underlines the need for developing globalizing and multi-sectoral interventions (diagnosis, therapeutic strategy, organization, health program, or health policies) in the perspective of bringing change and/or taking action in the Democratic Republic of Congo's emergency medical system.

Facteurs de demande de services de santé préventifs en contexte épidémique (Dengue et COVID 19), Côte d'Ivoire, 2020 / NA

Introduction : L'une des missions de l'Institut National d'Hygiène est de prévenir et contrôler les maladies transmissibles et autres urgences de santé publique à travers ses services compétents. En situation de crises sanitaires comme une épidémie, les besoins augmentent et alors les bénéficiaires sont exemptés de paiement pour toute intervention préventive de masse. Le paiement rentre en vigueur lorsque la demande est exprimée dans une perspective individuelle. L'objectif de l'étude était d'analyser les facteurs de la demande des prestations du service de lutte anti-vectorielle (LAV) en période épidémique de Dengue et de COVID-19. Méthodes : Une étude transversale a été réalisée de janvier 2018 à décembre 2020 dans une antenne communale, celle d'Abobo. La collecte des données a été effectuée à travers une revue documentaire et l'administration d'un questionnaire auprès du gestionnaire et des techniciens du centre. L'analyse des données a été réalisée avec le tableur Excel. Résultats : La recette cumulée du service LAV pour ces trois dernières années s'élèvait à 57 708 100 F CFA (≈ 88 103 €) avec une accentuation de l'ordre de 65,6% en 2020, année de pandémie à Covid-19. Les ménages ont été pour les trois années, les principaux demandeurs du service LAV. Leurs recettes cumulées s'élevaient à 22 663 120 FCFA (≈ 34 600 €). Les facteurs de la demande pour le service LAV étaient le lieu de résidence, le niveau d'instruction, le niveau de revenu et la source d'information. Conclusion: La pandémie à COVID 19 a favorisé une augmentation plus importante des recettes. Les gestionnaires du centre devront ajuster les objectifs de recettes en tenant compte des facteurs de la demande en service de soins préventifs.

Introduction: The National Institute of Hygiene's mission is to prevent communicable diseases andother public health emergencies. During health crises, beneficiaries are exempt from payment. The study's objective was to analyze the factors that influence the demand for vector control services during Dengue and COVID-19 epidemics. Methods: This was a cross-sectional study from January 2018 to december 2020 at the Abobo public health unit. Data collection was done through a literature review and the administration of a questionnaire. Data analysis was performed using Excel software. Results: The cumulative revenue of the LAV service for the last three years amounted to 57,708,100 F CFA (≈ 88,103 €). Households were the principal applicants for the LAV service for the three years. Their cumulative revenue amounted to 22,663,120 FCFA (≈ 34 600 €). Factors influencing demand for the LAV service were residence, level of education, income level, and source of information. Conclusion: Center managers will need to adjust revenue targets by considering demand factors for preventive care services.

Les urgences urologiques dans deux hôpitaux universitaires de Douala: une étude rétrospective (2016-2020) / Urological emergencies in two university hospitals in Douala: a retrospective study (2016-2020)

Introduction: les urgences en urologie sont des situations urologiques critiques qui nécessitent une intervention rapide par un professionnel de santé qualifié en urologie. Cette étude a été menée dans le but de ressortir le profil des urgences urologiques reçues dans deux hôpitaux universitaires de la ville de Douala en appréciant leurs prises en charge en urgence. Méthodes: il s´agit d´une étude rétrospective portant sur les urgences urologiques dans deux hôpitaux de références de la ville de Douala que sont les hôpitaux Laquintinie et Général de Douala. Les dossiers ont été colligés durant une période de 5 ans (1er janvier 2016 au 31 décembre 2020). Nous avons inclus toutes les consultations effectuées en urgence et reçues par le service des urgences ainsi que toutes les données cliniques et thérapeutiques venant du registre de garde durant la période d´étude. Nous avons exclu de notre étude toutes les urgences (consultations reçues pendant la période d´étude, non relevées dans le registre des urgences) Résultats: nous avons étudié 364 patients, l´âge moyen des patients était de 43 ± 8,34 ans. Quatre vingt-douze virgule cinquante huit pourcent (92,58%) (n=337) des patients étaient des hommes. Les principales urgences urologiques reçues étaient la rétention d´urine vésicale (45,05%, n=164), la colique néphrétique (15,33%, n=56) et l´hématurie (13,18%, n=48). Les principales étiologies des rétentions d´urine vésicale étaient les tumeurs prostatiques, la colique néphrétique était principalement d´origine lithiasique (96,45%, n=159) et l´hématurie était d´origine tumorale chez 68,75%(n=33) des patients. Sur le plan thérapeutique, les gestes effectués en urgence étaient le sondage vésical (39,01%, n=142), le traitement médical était associé à une surveillance (27,47%, n=100) et la cystostomie sus pubienne (10,71%, n=39). Conclusion: les rétentions aigues d´urines vésicales sur tumeurs prostatiques constituent l´urgence urologique la plus fréquente dans les hôpitaux universitaires de la ville de Douala. Cela implique une prise en charge précoce et optimale des tumeurs prostatiques.

Aspects épidémiologiques, diagnostiques et thérapeutiques des traumatismes vertébro-médullaires au Centre Hospitalier Universitaire d'Owendo, Gabon / Spinal cord injury at the Owendo teaching hospital, Gabon. Epidemiology, diagnosis and management

Spinal cord injury constitutes a multidisciplinary therapeutic emergency. It occurs usually in a context of polytrauma. The aim of this study was to describe the management of spinal cord injury admitted to the emergency department of a "trauma center". Methods: This is a prospective observational study carried out at the University Hospital of Owendo, Gabon. Patients admitted to the emergency department of any age for spinal cord injury and having performed a radiological examination were included. Socio-demographic parameters, circumstances and times of onset of trauma, mode of transport, state of consciousness, sensory and motor deficit, American Spinal Injury Association (ASIA) Score, hemodynamic and respiratory status were assessed. Results: During the study period, 850 patients were registered at the emergency department. Among them 112 were admitted for spinal cord injury (3.17%). The average age of the patients was 36 ± 3 years. The male gender accounted for 77% of cases. It concerned in 36% of cases the unemployed. The road accident was incriminated in 61%. Pedestrians were involved in 81% of cases. The clinical evaluation on admission found a sensorimotor deficit in 45 patients (40.17%), there were 11 tetraplegias (10%) and 3 paraplegias (3%). The majority of patients (77.7%) were classified as Fränkel stage A. The lesions were dominated by dislocations of the cervical spine (30.4%). Specialized care was essentially orthopedic in 60.7%. No patient was operated. Conclusion: Spinal cord injuries are "time-dependent" medical and surgical emergencies. A codified organization of pre-hospital care and an efficient "trauma center" are essential factors for the management of this type of traumatic pathology

Traumatismes abdominaux graves aux urgences du «Trauma Center¼ de Libreville: Aspects épidémiologiques, diagnostiques et évolutifs / Severe abdominal trauma in the emergency room of the Trauma Center Libreville: Epidemiological, diagnostic and evolutionary aspects

Les traumatismes abdominaux représentent environ 15-20 % des lésions observées en traumatologie. L'objectif est de décrire les aspects épidémiologiques, diagnostiques et évolutifs des traumatismes abdominaux graves admis aux urgences du Centre Hospitalier Universitaire d'Owendo (CHUO) au Gabon. Méthodes : Il s'agit d'une étude rétrospective transversale et descriptive. Elle s'est déroulée sur une période de vingt quatre mois de 2020 à 2021 aux urgences du CHUO. Seuls les patients présentant une pathologie abdominale traumatique classée grave ont été inclus. Les variables de l'étude étaient : l'âge, le genre, le mécanisme du traumatisme, la prise en charge pré hospitalière, les signes cliniques, le bilan paraclinique réalisé, le traitement chirurgical et l'évolution. Les données ont été analysées par le logiciel Microsoft Excel© Pro version 2019. Résultats : durant cette période, 4,6% (n=105) des patients présentaient un traumatisme abdominal dont 66,7% (n=70) avaient un traumatisme abdominal grave. L'âge moyen des patients était de 29,8 + 13,8 ans. Dans 70% des cas (n=49), les accidents de la voie publique étaient le principal mécanisme étiologique, puis secondairement les agressions avec 11,4% des cas. En per opératoire, les lésions spléniques représentaient 60% (n=42) des cas. La mortalité brute était de 20% (n=14). Les décès étaient survenus chez 64,2% de patients au cours des quarante-huit premières heures. Conclusion : A Libreville, les accidents de la voie publique représentent le principal pourvoyeur des traumatismes abdominaux graves. Ces urgences restent encore responsables d'une forte mortalité au Gabon

Vaccination contre la Covid-19: droits des personnes et obligations du Gouvernement Congolais en période d'urgence sanitaire

Cette étude avait pour objectif de mettre en exergue le rapport entre le bénéfice de la couverture vaccinale contre la Covid-19 et les risques individuels et collectifs encourus par la population. A travers le monde, les études ont monté que les campagnes de vaccination ont insufflé une dynamique positive à la lutte contre la pandémie et la courbe de la maladie a fléchi dans les populations vaccinées. Face à ces résultats probants, le législateur congolais doit s'en inspirer pour proposer des instruments juridiques en faveur d'une vaccination obligatoire contre la Covid-19 soumise à tous les citoyens et citoyennes Congolais sans exception. Si tout le monde peut être contaminé, tout le monde peut également faire preuve d'un certain degré de citoyenneté responsable pour réduire les risques de contracter la maladie et ne pas la transmettre à son entourage. La couverture vaccinale contre la Covid-19 est une des mesures de l'incidence de la maladie dans la population et qui ne peut prendre la quasi-totalité de la population qu'en la rendant obligatoire.

COVID-19 Pandemic as a mass killer and existential public health emergency in Nigeria remains unproven: A viewpoint

Framing COVID­19 pandemic as mass killer and existential public health emergency/threat in Nigeria with 2,120 COVID­19­related deaths in over 14 months of the pandemic in the country is problematic, especially as other public health conditions kill more Nigerians annually. In 2018, for example, malaria and road traffic accident caused 97,200 and 38,902 deaths, respectively, while HIV/AIDS caused 43,000 deaths in 2019. Therefore, rushing into an extensive vaccination campaign projected to cost 540 billion naira when 76.03 billion naira was allocated for primary health services nationwide including other major immunization programs in the 2021 federal health budget could raise question of priority/effective spending. Especially with COVID-19 deaths relative to reported cases(case fatality ratio) declining to 1.30% by June 30, 2021 from 3.45% in April 2020 and daily mass deaths non-evident. Temporizing to understand how the pandemic evolves especially in jurisdictions with higher need could be cost­effective.

Evaluating the response to the scourge of Coronavirus pandemic in poor resourced countries : the case of Zimbabwe

Towards the end of 2019 the world woke up to a novel virus which has come to be known as the Coronavirus (COVID-19). COVID-19 is threatening to reorder and reconfigure the world order in all spheres of life. Global infection rate has now surpassed two million. The World Health Organisation (WHO) has declared COVID-19 as a public health emergency of international concern. Worldwide there are measures and guidelines formulated to contain the pandemic. This paper evaluates the response of poor resourced countries to the scourge of COVID-19 and the measures or responses initiated to fight Coronavirus in poor resourced economies like Zimbabwe. The various measures taken by the Zimbabwean government to curb the spread of the virus in the country include onsite screening lockdown holding returning residents in isolation for a period of 21 days as well as public enlightenment and awareness about COVID-19. Notably these measures are laudable and commendable; however more is needed to ensure the spread of the disease is effectively managed and contained. Compulsory testing and enforcement of such best practices as social distancing and confinement to homes or self-isolation are desirable

Profile of dog bite injuries in patients presenting at Kimberley Hospital Complex's emergency and gateway centres, 2015 to 2017

Background: Dog bite injuries in humans remain a public health problem. There is limited nationally representative data on the magnitude of the problem and the epidemiological profile of dog bite injuries in South Africa. Aim: To describe the profile of dog bite injuries in patients presenting to Kimberley Hospital Complex (KHC) emergency and gateway centres. To determine the prevalence of dog bite injuries amongst all patients presenting to these centres and the compliance of mandatory notification of dog bites. Setting: Kimberley Hospital Complex emergency and gateway centres. Methods: A retrospective review of all dog bite cases who presented to KHC from August 2015 to July 2017. The total number of all patients who presented were taken into consideration for calculating the prevalence of dog bite cases. Results: During the study period, 433 dog bite cases were identified out of 107 731 patients seen at emergency and gateway centres, giving a prevalence of 0.4%. Of all cases, 62.4% were male patients and 37.6% were female patients. Most affected age group was between 10 and 19 years (19.6%). Category II exposure type accounted for the majority of the cases (59.4%). Unvaccinated dogs were incriminated in 61.9% of cases. Stray dogs were responsible for 83.1% of all injuries. More than half of the cases (47.9%) were notified by the treating doctors. Conclusion: Dog bite injuries in Kimberley were commonest in children and adolescents. The prevalence tended to decrease in adulthood with advancing age groups. Most bites resulted from unvaccinated stray dogs. Only about half of the cases were notified to the appropriate authorities. Prevalence of dog bite injuries amongst patients presenting at KHC resulted in the low rate of 0.4%. Awareness needs to be created amongst health care providers on the importance of notification of all exposure to rabies. More efforts are required at the prevention of dog bites in children and adolescents through stringent measures to limit the number of free-roaming dogs

Transfusion, mortality and hemoglobin level: associations among emergency department patients in Kigali, Rwanda

Background: Studies from high-income countries (HIC) support restrictive blood transfusion thresholds in medical patients. In low- and middle-income countries (LMIC), the etiologies of anemia and baseline health states differ greatly; optimal transfusion thresholds are unknown. This study evaluated the association of packed red blood cell (PRBC) transfusion with mortality outcomes across hemoglobin levels amongst emergency center (EC) patients presenting with medical pathology in Kigali, Rwanda. Methods: This retrospective cohort study was performed using a random sample of patients presenting to the EC at the University Teaching Hospital of Kigali. Patients ≥15 years of age, treated for medical emergencies during 2013­16, with EC hemoglobin measurements were included. The relationship between EC PRBC transfusion and patient mortality was evaluated using logistic regression, with stratified analyses performed at hemoglobin levels of 7 mg/dL and 5 mg/dL. Results: Of 3609 cases sampled, 1116 met inclusion. The median age was 42 years (IQR 29, 60) and 45.2% were female. Transfusion occurred in 12.1% of patients. Hematologic (24.4%) and gastrointestinal pathologies (20.7%) were the primary diagnoses of those transfused. Proportional mortality was higher amongst those receiving transfusions, although not statistically significant (23.7% vs 17.0%, p=0.06). No significant difference in adjusted odds of overall mortality by PRBC transfusion was found. In stratified analysis, patients receiving EC transfusions with a hemoglobin >5.0 mg/dL, had 2.21 times the odds of mortality (95% CI 1.51­3.21) as compared to those ≤5.0 mg/dL. Conclusions: No association between PRBC transfusion and odds of mortality was observed amongst EC patients in this LMIC setting. An increased mortality association was found for patients receiving PRBC transfusions with an initial hemoglobin >5 mg/dL. Results suggest benefits from PRBC transfusion are limited as compared to HIC. Further research evaluating emergent transfusion thresholds for medical pathologies should be performed in LMICs to guide practice

Trauma burden, patient demographics and care-process in major hospitals in Tanzania: a needs assessment for improving healthcare resource management

Background:Appropriate referrals of injured patients could improve clinical outcomes and management ofhealthcare resources. To gain insights for system development, we interrogated the current situation by assessingburden, patient demography, causes of injury, trauma mortality and the care-process.Methods:We used an observational, cross-sectional study design and convenience sampling to review patientcharts from 3 major hospitals and the death registry in Tanzania.Results:Injury constitutes 9­13% of the Emergency Centre census. Inpatient trauma-deaths were 8%; however,the trauma death registryfigures exceeded the'inpatient deaths'and recorded up to 16%. Most patients arrivethrough a hospital referral system (82%) and use a hospital transport network (76%). Only 8% of the traumaadmissions possessed National Health Insurance. Road traffic collision (RTC) (69%), assault (20%) and falls (9%)were the leading causes of injury. The care process revealed a normal primary-survey rate of 73­90%.Deficiencies in recording were in the assessment of: Airway and breathing (67%), circulation (40%) and dis-ability (80%). Most patients had non-operative management (42­57%) or surgery for wound care or skeletalinjuries (43%). Laparotomies were performed in 26%, while craniotomy and chest drain-insertion were eachperformed in 10%.Conclusion:The burden of trauma is high, and the leading causes are: RTC, assault, and falls. Deaths recorded inthe death registries outweigh in-hospital deaths for up to twofold. There are challenges in the care process,funding and recording. We found a functional hospital referral-network, transport system, and death registry

An assessment of Nurses' knowledge, attitude and practice of emergency care related to road traffic accident victims at three selected hospitals in Rwanda

Introduction:Quality emergency nursing care is an important variable in reducing death and disability due to road traffic accidents (RTA), yet little is known about emergency nursing care within the Rwandan context. This study aims to describe the knowledge, attitude and practice (KAP) of nurses of the emergency care of RTA patients.Method:We employed a cross sectional design to survey the full cohort of nurses working in Accident and Emergency (A&E) units in three selected Rwandan hospitals (N = 51). Results:This study revealed that the knowledge and practice of nurses is either high or very high and the majority of them (73.657%) had a positive attitude towards emergency management of RTA patients. Being trained before working in A&E units was associated with a significant increase in the likelihood of being at thelevel of practice which is (1) very high (OR = 5.35, 95%, CI = 5.20­5.50), (2) high (OR = 1.60, 95%,CI = 1.17­2.19) (3), moderate (OR = 5.35,95%, CI = 4.15­6.88) and (4) low (OR = 1.33,95%, CI = 1.33­133)and it decreased more than 99.9% the likelihood of being at low level of practice in all levels.Discussion:The study showed that training had a significant effect on practice and this is supported by previousstudies. Training interventions to improve the management of RTA patients by nurses working in A&E should beregularly audited to ensure ongoing quality of care

Connaissances et attitudes face aux péricoronarites: enquête auprès des chirurgiens-dentistes de Dakar (Sénégal)

INTRODUCTION: Une prise en charge efficace des urgences parodontales contribue au bien-être physique et psychologique du patient. L'objectif de ce travail était d'évaluer les connaissances, attitudes et pratiques des chirurgiens dentistes de Dakar face aux péricoronarites. MATÉRIELS ET MÉTHODES: Il s'est agi d'une enquête transversale descriptive réalisée auprès des chirurgiens dentistes de la région de Dakar et exerçant dans des structures privées, publiques et parapubliques. L'inclusion était basée sur la liste officielle de l'ordre national des chirurgiens dentistes du Sénégal (ONCD) de la région de Dakar de l'année 2015, et de celle du service de santé des Armées Sénégalaises. RÉSULTATS: L'échantillon comprenait 122 chirurgiens dentistes, dont 65 hommes. Le secteur public est le plus représentatif avec un pourcentage de 44,26%. Dans notre échantillon, 84,43% des dentistes prescrivent des antibiotiques et des analgésiques et 41,80% réalisent une détersion des lésions avec une boulette de coton imbibée de peroxyde d'hydrogène à 10 volumes. Cependant, 64,75% des dentistes font une excision du capuchon muqueux en urgence. CONCLUSION: La prise en charge de la péricoronarite n'est pas toujours conforme aux recommandations scientifiques actuelles. Afin de ne pas compromettre le potentiel de cicatrisation du parodonte, la formation continue des chirurgiens dentistes sénégalais devrait être un impératif éthique et légal

Barriers and enablers to task shifting for caesarean sections in sub-saharan africa: a scoping review

Task shifting of Caesarean-sections to non-physician clinicians (NPCs) has raised concerns over NPCs' competences and rationale of using them in facilities where medical doctors (MDs) are scarce to provide mentorship. We conducted a scoping review to provide an update on NPCs' contribution to C-sections including barriers and enablers to task shifting. Using the PRISMA Flow Diagram, we identified 15 eligible articles from Google Scholar, PubMed and Africa Index Medicus using specific search terms and a pre-established inclusion criterion. All 15 studies characterised NPCs: their names, training, challenges and enablers to task shifting. NPCs performed 50%-94% C-sections. Outcomes of such C-sections were comparable to those performed by MDs. Enablers included supportive policies, pre-existing human resources for health shortage, well-resourced health facilities and supervision of NPCs. Weak health systems were major barriers. While NPCs make a significant contribution to accessing C-sections services, there is need to address challenges to fully realize benefits

The use of emergency hormonal contraception in South Africa: current and future perspectives

Emergency hormonal contraceptives play an important role in preventing unplanned pregnancies in South Africa. In this review,we discuss the levonorgestrel emergency contraceptive, the combined estrogen and progestin regimen (also known as the Yuzpe method) and the use of Ulipristal acetate. The levonorgestrel and the combined estrogen, progestin regimen are available in South Africa. The specific mechanisms of action of each of these emergency hormonal contraceptives will be discussed as well as their efficacy, the side effects associated with each of these preparations and the drug interactions. Levonorgestrel can be used as a single dose (1.5 mg) instead of two doses (0.75 mg) 12 hours apart. Levonorgestrel is very effective, with fewer adverse effects than the combined estrogen and progestogen administration. Levonorgestrel and the Yuzpe method have demonstrated good efficacy when utilised within 72 hours after unprotected intercourse or contraceptive failure. These emergency hormonal contraceptives should not be used as regular contraception. It is essential that all health professionals and educators inform women of reproductive age about the risks and common side effects of emergency hormonal contraceptives

Outcome of hyperglycemic emergencies in a tertiary hospital, South East, Nigeria

Background: Hyperglycemic emergency (HE) is typically represented by diabetic ketoacidosis, (DKA) and hyperosmolar hyperglycemic state (HHS). It is a common cause of hospitalization due to diabetes mellitus (DM) and is associated with considerable mortality. In South East Nigeria, there is a paucity of studies on the treatment outcome of HE, hence the need for this study. Objective: The aim and objective of the study were to determine the outcome of treatment of adult persons living with diabetes managed for HE at Federal Medical Centre (FMC), Umuahia. Materials and Methods: This was a prospective study in which 110 consecutive adult patients managed for HE at FMC, Umuahia, were recruited. Data obtained included a total number of medical and diabetic admissions within the study period. For participants that met the inclusion criteria for the study, their bio­data, blood pressures, level of consciousness at presentation or while being treated, random plasma glucose, plasma electrolytes, urea, creatinine, and plasma 3­beta­hydroxybutyrate were noted and/or measured. Similarly, urine sample was collected from each participant for analysis (glucose, protein, and ketone). The outcome measures were patient's survival, hospitalization duration, and death. Analysis of data was done using SPSS 20.0 and the level of statistical significance was set at P < 0.05. Results: Of the 110 participants recruited, there were 46 (41.8%) males and 64 (58.2%) females. HE constituted 15.6% of the total medical admissions within the study period with a mortality of 10%. DKA and mixed form of HE were the predominant patterns in the study. While hospitalization duration was variable, no female participant was discharged against medical advice. Conclusion: The study showed that HE is a frequent acute complication of DM in this region ofNigeria and that HE typically presents as DKA and mixed form. Hospitalization for HE had a variable duration with a significant mortality

Emergency Centre-based paediatric procedural sedation: current practice and challenges in Cape Town

Background: The aims and objectives of this survey of the current practice of doctors working in Emergency Centres (ECs) in the Cape Town metropole was to assess clinical practice and attempt to identify obstacles to the practice of paediatric procedural sedation and analgesia (PPSA). This was considered essential to establish a baseline for quality assurance purposes and improvement. Methods: After institutional ethics approval, a cross-sectional descriptive study was performed in 25 ECs in both private and government sectors in Cape Town. Specific aspects of PPSA practice were analysed after the anonymous completion of a specifically designed questionnaire, by full-time doctors working at each EC. The doctors' grade and training, practice preferences, medication and use of monitoring, and any perceived challenges to performing PPSA were assessed. Results: Sixteen ECs agreed to be part of the study and 62 questionnaires were completed (a 64% response rate). Procedural sedation and analgesia was performed at all the participating ECs, by medical practitioners of varying experience. Doctors' awareness of unit protocols was inconsistent. Common indications were orthopaedic interventions, radiological investigations and surgical procedures. Medications used were similar in the responding units, but dosages varied. Monitoring was poor compared with local and international standards. The obstacles reported predominantly related to a lack of training and formal protocols. Conclusions: This study was the first to evaluate the practice of Emergency Centre paediatric procedural sedation and analgesia practice in a South African setting. The lack of a formal system of training and accreditation, for both doctors and facilities, and the need for institutional and nationwide PPSA guidelines were highlighted

Profil épidémiologique et clinique des urgences cardiovasculaires à Conakry

Objectif : décrire les aspects épidémiologiques et cliniques des urgences cardiovasculaires au service de Cardiologie de l'Hôpital National Ignace Deen de Conakry. Patients et méthode : Il s'agissait d'une étude prospective descriptive d'une durée de six (06) mois, du 28 janvier au 28 juillet 2017. Elle a porté sur l'ensemble des patients admis et hospitalisés au service pour une urgence cardiovasculaire avec des critères de définition correspondant aux normes internationales pour chaque urgence. Résultats : L'étude a porté sur 119 patients reçus en urgence dans le service pendant la période d'étude. Il y avait 69 hommes (57,9 %) et 50 femmes (42,1). Le sex-ratio H/F était de 1,38. La fréquence des UCV était de 27,9 %. Les principales urgences cardiovasculaires étaient représentées par l'insuffisance cardiaque décompensée (28,6 %) suivie des urgences hypertensives (21,8 %) et de l'infarctus du myocarde (18,5 %). Le délai entre le début des symptômes et l'hospitalisation était en moyenne de 5,7 jours. Les pathologies sous-jacentes les plus fréquentes étaient représentées par l'HTA (48,7 %), les valvulopathies (28,6 %) et les myocardiopathies (10,1 %). Le facteur de risque cardiovasculaire essentiel que nous avons observé était l'hypertension artérielle dans (27,7 %). L'évolution a été favorable dans 85,7% des cas, malheureusement 14, 3 % cas de décès ont été enregistrés. Conclusion : Ces urgences constituent un problème majeur de santé dans notre pays compte tenu de l'insuffisance du plateau technique. L'accent doit être mis sur la prévention des affections cardiovasculaires