Leishmaniose cutanée : étude épidémiologique et clinico-biologique dans deux hôpitaux publics de Nouakchott

De nombreux cas de leishmaniose cutanée sont observés lors des consultations hospitalières à Nouakchott. L'objectif de notre étude est de recueillir tous les cas de leishmanioses cutanées à Nouakchott et d'en étudier les caractéristiques épidémiologiques et clinico-biologiques. Méthode : Il s'agit d'une étude multicentrique descriptive prospective réalisée dans 2 services hospitaliers spécialisés de Nouakchott du 1er septembre 2016 à la fin du mois d'octobre 2017. Tous les patients présentant des lésions suspectes de leishmaniose cutanée durant cette période ont été retenus. Un prélèvement cutané à visée parasitologique, une PCR et une histologie ont été effectués aux patients. Résultats : Vingt et un patients sur 9000 consultants ont été diagnostiqués durant la période d'étude, avec un âge moyen de 23 ans (variant de 3 à 70 ans). Une prédominance masculine a été notée avec un sexe ratio de 2/1. Les localisations les plus fréquentes sont les parties découvertes du corps (les 4 membres). La forme ulcéro-crouteuse est rencontrée dans 2/3 des cas. L. major est plus fréquemment identifiée (61,9 %) suivi de L infantum dans 23,8% des cas. L'Antimoniate de Meglume a été administré par voie intralésionnelle chez 57,1% des patients. A Nouakchott, la Leishmaniose cutanée n'est pas rare. Les cas observés sont liés à une origine ou un séjour dans les régions du Sud

A case report of ectopia cordis and omphalocele.

A rare congenital defect in fusion of the anterior chest wall resulting in an extrathoracic location of the heart. Cantrell’s pentalogy is a congenital anomaly resulting from embryologic development defect and consists of the following: A deficiency of the anterior diaphragm, a midline supraumbilical abdominal wall defect, a defect in the diaphragmatic pericardium, congenital intracardiac abnormalities, and a defect of the lower sternum. Here

Unusual manifestation of Marden-walker syndrome.

Marden-Walker syndrome (MWS) is characterized by multiple joint contractures, a mask-like face with blepharophimosis, micrognathia, high-arched or cleft palate, low-set ears, decreased muscular bulk, arachnodactyly, and kyphoscoliosis. We report a case of MWS along with unusual manifestation of neurological, cardiovascular, and genitourinary system.

Neonatal resuscitation training programme, its efficiency at rural hospital

Birth asphyxia is one of the commonest causes of neonatal mortality and morbidity. Prompt and proper application of various management strategies as per standard American Academy of Pediatrics [AAP] neonatal resuscitation guidelines will help to prevent birth asphyxia and decrease the consequent/resultant mortality and morbidity. Neonatal resuscitation is an essential skill in maternal and child health, and every health care personnel should know the basic steps of resuscitation. Thus, the neonatal resuscitation training programmed [NRTP] was conducted based on the latest international 2005 AAP neonatal resuscitation guidelines. A set of multiple choice questions for both pre- and post-tests was administered before and after the NRTP to assess the knowledge and skill gained by the participants. The NRTP was conducted by the Department of Pediatrics, MGIMS, KHS Hospital Sevagram. The participants were undergraduate, postgraduate and nurses. Before starting the lectures, participants were given the pre-test consisting of 35 multiple choice questions covering the entire NR protocol based on AAP Neonatal Resuscitation guidelines. The post-test was administered at the end of the training programmed. The participants' pre- and post-test marks were categorized into very good score [>/= 80%], good score [60-80%], and unsatisfactory score [<60%]. The t-test for paired samples was calculated using SPSS 10 version. A total of 107 participants who were given pre- and post-tests were included in the study group. Maximum participants were final year undergraduate students [55.14%] followed by B.Sc. nursing students [12.14%] and staff nurses [11.21%]. The mean pre-test score was 17.56 [SD +/- 4.68] that went up to 27.71 [SD +/- 2.36] as a mean post-test score [p value <0.000; 95% CI -10.92 to -9.37]. The highly significant improvement was observed in the post-test scores of MBBS final year students [p < 0.000; 95% CI -11.28 to -9.73], staff nurses [p < 0.000; 95% CI-11.58 to -8.71], community postgraduates [p < 0.000; 95% CI-8.22 to -5.43], and B.Sc. nursing students [p < 0.000; 95% CI -18.59 to -13.07]. Significant improvement was also observed in the post-test scores of anesthesia postgraduates, gynecologist postgraduates, medical officers, and pediatrics postgraduates

Lizard bite in Indian child : Case report.

Lizard bite is very uncommon in children. Here we report a child who had bitten by lizard on the right thumb and recovered without any complication.

Pain response of neonates to venipuncture.

OBJECTIVE: To study the physiological and behavioral response to pain. METHODS: 80 healthy neonates requiring bilirubin estimation, blood sugar etc, were randomly assigned to receive a venous puncture. All parameters were recorded 10 minutes prior, during and 10 minutes after the procedure. Evaluated NIPS score and RR. HR, NIBP and O2 saturation observed on Datex-Ohmeda multimonitor. RESULTS: After the venepuncture, heart rate (p<0.001) and blood pressure (p<0.001) were significantly increased in both the groups but more significant increase was present in Group I (>2.5 kg) as compared to Group II (>2.5 kg). Respiratory rate was also increased but more significant in Group II (p<0.001) whereas oxygen saturation was decreased in both the groups but more significant in Group I (p<0.001). Median Neonatal Infant Pain Scale (NIPS) score was higher in both the Groups (p<0.001). CONCLUSION: The outcome measures appear to be reliable indices of term neonates responses to painful stimulation. NIPS are suitable instruments for neonatal pain evaluation.

Mobile phones and cardiac pacemakers

There is a growing body of evidence from in vitro and in vivo studies that mobile phones may cause electromagnetic interference with implanted cardiac pacemakers. Pacemaker-dependent patients without an appreciable underlying rhythm are at greatest risk from these effects. There is, however, an overwhelming lack of knowledge about this subject among physicians, partly because of the rarity of publications on this subject in medical journals. In this article we present a summary of available literature on such interactions and try to reach general recommendations

Gemella morbillorum endocarditis

A case of Gemella morbillorum [G.morbillorum] endocarditis of the mitral valve in a patient with previously normal heart valves is reported. The presentation was subacute, and the infection was complicated by perforation of the posterior mitral leaflet that necessitated valve repair. Gemella morbillorum infections are uncommon, and endocarditis is the most common presentation. G.morbillorum endocarditis is probably under recognized, and has not been reported from our region. The case is described, and problems in the identification of the organism are discussed

Correçäo da anemia da insuficiência renal crônica pela eritropoetina humana recombinante liofilizada por via subcutânea / Anemia correction of chronic kidney failures by recombinant human erythropoietin freeze drying by subcutaneous injections

A eritropoetina recombinante humana (rHuEPO) tem-se mostrado a medicaçäo de escolha na correçäo da anemiado paciente renal crônico. OBJETIVO. Analisar a eficácia de uma nova preparaçäo de rHuEPO na correçäo da anemia de pacientes renais crônicos mantidos em hemodiálise, exclusivamente administrada por via subcutânea, estudando seus efeitos colaterais e pesquisando fatores preditivos de resposta para a medicaçäo. MÉTODOS. Doze pacientes em programa regular de hemodiálise foram tratados com rHuEPO liofilizada por via subcutânea, durante 18 meses, com dose inicial de 20U/Kg/diálise, efetuando-se monitorizaçäo clínica e laboratorial adequada. RESULTADOS. Onze pacientes terminaram o protocolo, alcançando hematócrito (Htc) alvo de 30 por cento e mantendo-o durante todo o tempo de estudo. A dose média utilizada para a correçäo da anemia foi de 65U/Kg diálise e a de manutençäo de Htc alvo de 51U/Kg diálise. Já na 12ª semana do estudo, comprovou-se aumento significativo do Htc (18,4 ñ 3,5 por cento vs. 25,4 ñ 3,8 por cento, p < 0,5), acompanhado por hemoglobina e eritrócitos. Leucócitos e plaquetas aumentaram significativamente a partir da 24ª semana e mantiveram-se assim até o final do estudo. Na análise dos exames bioquímicos dos pacientes, apenas o potássio se elevou na 4ª e 12ª semanas, voltando ao basal na 24ª semana de estudo. A avoluçäo dos parâmetros séricos do metabolismo do ferro mostrou diminuiçöes intermitentes e estatisticamente significantes da saturaçäo de transferrina na 1ª, 12ª e 24ª semanas, voltando aos valores basais ao final do estudo; a ferritina sérica näo se alterou (582,7 ñ 700,9ng/mL vs. 700,0 ñ 651,6ng/mL). Peso e pressäo arterial näo se alteraram, porém dois pacientes, antes normotensos, tornaram-se hipertensos e dois outros, com hipertensäo controlada, necessitaram reajuste de droga para novo controle da pressäo (35 por cento). Um paciente apresentou convulsäo tipo grande mal, evoluindo sem seqüelas. CONCLUSAO. A rHuEPO utilizada neste protocolo comprovou ser uma droga eficaz, segura e com efeitos colaterais passíveis de controle