ABSTRACT
The purpose of this study is to analyze the effectiveness of surgery and follow-up of children operated on for burn sequelae. For many years, we have organized two missions per year to Benin and Togo, one for surgery and one for follow-up. We analyzed the files of children born in Africa and victims of burns from the years 2002 to 2011. Children were referred through a non-governmental organization (NGO) and assessed in Africa by local paediatricians before and after surgery. Treatment consisted in operating on burn sequelae such as contractures, hypertrophic scars and hard cords. Impaired mobility was our only indication for the operation. We kept a database on all patients. Sixty files were reviewed, of which fifty were deemed suitable for analysis. The most common methods of surgery were skin grafting and Z-plasty. There were no complications, such as infection or graft/flap necrosis after immediate surgery. Long-term follow-up revealed a recurrence of hypertrophic scarring (47%), retractions (24%) and hard cords (2%) due to a lack of occupational therapy and physiotherapy treatment. Partnership with an NGO and a local team allows us to treat children with burn injury sequelae in Western Africa. A continued and often long-lasting follow-up by occupational therapists and physiotherapists is highly mandatory in order to guarantee good long-term results. In 2010, we initiated local rehabilitation therapy.
Le but de cette étude est d'analyser l'efficacité de la chirurgie et le suivi d'enfants opérés pour des séquelles de brûlures. Nous avons analysé les dossiers d'enfants africains, victimes de brûlures depuis l'année 2002 jusqu'en 2011. Pendant de nombreuses années, nous avons organisé deux missions par an au Bénin et au Togo, une pour la chirurgie et une pour le suivi. Les enfants nous étaient confiés par une O.N.G. et examinés en Afrique par des pédiatres locaux avant et après la chirurgie. Le traitement chirurgical s'adressait aux séquelles de brûlures telles que rétractions, cicatrices hypertrophiques et brides. La perte de mobilité fut notre unique indication. Nous avons une base de données sur tous les patients. 60 dossiers furent revus mais 50 retenus pour l'analyse. Les traitements les plus fréquents furent la greffe de peau et les plasties en Z. Il n'y a pas eu de complications, ni infection ou nécrose de la greffe ou du lambeau après chirurgie immédiate. Le suivi à long terme a montré une récidive des cicatrices hypertrophiques (47%), des rétractions (24%) et des brides (2%), et ceci dû à une absence d'ergothérapie et de physiothérapie. La coopération avec une O.N.G. et une équipe locale a permis de traiter ces enfants présentant des séquelles de brûlures en Afrique de l'Ouest. Un suivi continu et souvent long par les ergothérapeutes et les physiothérapeutes est indispensable, si l'on veut garantir de bons résultats à long terme. En 2010 nous avons initié localement un traitement par rééducation fonctionnelle.
ABSTRACT
UNLABELLED: Meticillin resistant Staphylococcus aureus (MRSA) is among the most important causes of nosocomial infections. It possesses a particular ability to spread in hospitals worldwide. OBJECTIVE: To analyze the proportion of MRSA among S. aureus isolated from specimen taken for diagnosis purposes. To make the medical staff aware of the problem of MRSA infections and to take a better care of patients. PATIENTS AND METHODS: During 3 months, a prospective study was carried out in the neonatal unit of centre hospitalier départemental du Zou et Collines in Benin. We identified newborn carriers of SA, particularly MRSA and factors associated with the carriage. Two hundred and ninety patients were admitted in the 3 divisions of the neonatal unit. From 195 specimens examined for diagnosis purposes 48 h after hospitalization, 112 patients were detected by nose swabbing. Concurrently, swabbing of environment was achieved. RESULTS: Among patients'specimens, 141 isolations of S. aureus were observed. The proportion of MRSA was 36% amongst diagnostic specimens. MRSA represented 39% of the environment specimens. None of the isolated MRSA produces Panton Valentine leukocidin. CONCLUSION: Our survey revealed a high level of MRSA among S. aureus isolated from diagnostic specimens. Consecutive to such findings and for decreasing nosocomial infection, an appropriate prevention program was installed, including intensive promotion of hands hygiene, correct sterilization and disinfection of materials and patients.
