Gestion de la qualité des soins au service d'acceuil des urgences (SAU) de l'hôpital du Mali: enjeux et perspectives / Management of the quality of care at the emergency reception service (SAU) of the hospital of Mali : challenges et perspectives

Introduction : La Neurochirurgie au Mali reste une discipline relativement jeune par rapport aux autres spécialités chirurgicales. Le but de ce travail est de décrire le parcours des urgences neurochirurgicales admises au SAU de l'hôpital du Mali.Patient et méthodes : C'est une étude prospective transversale analytique qui s'est déroulée au SAU de l'hôpital du Mali sur une durée de 02 mois. Sont inclus dans cette étude, tous les patients admis au SAU et dont on a eu recours à un avis neurochirurgical. Nous avons recensé et analysé les données épidémiologiques, cliniques, paracliniques et thérapeutiques chez 82 patients. Résultats : Sur un total de 152 patients admis au SAU, il y'avait 82 cas pour lesquels un avis neurochirurgical a été demandé soit 53, 95 % des admissions. Parmi ces 82 patients, il y avait 50 cas de traumatismes crâniens, 20 cas de traumatismes du rachis, 08 cas d'accident vasculaire cérébral hémorragique (AVCH), 03 cas de suppurations intracrâniennes et 01 cas de tumeur cérébrale. Nous avons opéré 41 patients (50%) et mis en observation 32 patients (39,02%). Malgré nos efforts, 09 patients sont sortis contre avis médical ou par faute de moyens. Nous avons noté 03 cas de décès. Conclusion : La qualité des soins et l'accès aux soins sont très souvent considérés par les patients comme les éléments essentiels de la performance d'un système de santé. En tant que Etablissement Public Hospitalier (EPH) de niveau 3, il doit bénéficier d'un plateau technique adéquat et d'un personnel médical et paramédical suffisant afin d'assurer une prise en charge correcte des patients

Introduction : Neurosurgery in Mali remains a relatively young discipline compared to other surgical specialties.The aim of this study is to describe the course of neurosurgical emergencies in "Hôpital du Mali". Patients and methods: This is a prospective cross-sectional analytical study that took place at the emergency department of "hôpital du Mali" over a period of 02 months. Are included in this study, all the patients admitted in emergency for whom neurosurgical advice was sought. We identified and analyzed epidemiological, clinical, paraclinical and therapeutic data in 82 patients.Results: Out of a total of 152 patients admitted to our emergency unit, there were 82 cases for which a neurosurgical opinion was requested, ie 53.95% of admissions. Among these 82 patients, there were 50 cases of head trauma, 20 cases of spinal trauma, 08 cases of brain stroke, 03 cases of intracranial suppurations and 01 case of brain tumor. We operated on 41 patients (50%) and observed 32 patients (39.02%). Despite our efforts, 09 patients were released against medical advice or for lack of funds. We noted 03 cases of death. Conclusion: The quality of care and access to care are very often seen by patients as essential elements of the performance of a health system. As a level 3 public hospital, it must have an adequate technical platform and sufficient medical and paramedical staff to ensure correct patient care

[Diagnosis and surgical traitment of intracerebral hydatic cyst in Mali]. / Diagnostic et traitement chirurgical du kyste hydatique cerebral au Mali.

AIMS: Cerebral hydatic cysts are common in North African and pastoral countries but still underdiagnosed in sub-saharian ones.We report the first two casesoperated in Mali andhistologically proven of cerebral hydatic cysts. PATIENTS AND METHOD: Our study was aboutabout a 46 years old patient, admitted for Bravais-Jacksonian crisis, dysarthry and right hemiparesy, and another 38 years old male one, with a intracranial hypertension syndrome associated with cranial fistulized cerebral hydatic cyst.The CT scan has shown a cerebral cyst in the first case and multi-locular cysts in the second. The patients underwent surgery, with complete removal in one case and a rupture in the second case, but with a good outcome. Anatomo-pathological analysis concluded to hydatic cerebral cysts in both cases. CONCLUSION: With these first cases, the diagnosis of cerebral hydatic cyst must be evoked more frequently in our countries, because of the evolution of radiological diagnosis and surgical abilities.

INTRODUCTION: L'hydatidoseest une parasitose frequente dans les pays d'elevage de moutons (maghreb). Le kyste hydatique cerebral en est une localisation rare (1 a 4%) et souvent meconnue en afrique sub-saharienne. Nous rapportons2 cas de kystes hydatiques cerebraux operes au Mali. OBSERVATIONS: Le premier patient de 46 ans, cultivateur et éleveur, vivant en milieu rural, admis pour crises convulsives Bravais-Jacksoniennes, dysarthrie et hémiparésie droite. Le deuxième, âgé de 38 ans présentait un syndrome d'hypertension intra-crânienne et une tuméfaction occipitale fistulisée. La tomodensitométriecérébrale a objectivé une lésion kystique unique dans un cas et multi-cloisonnée dans le deuxième cas. Après concertation pluridisciplinaire, le diagnostic de kyste hydatique a été évoqué.Une exérèse complète des lésions a été effectuéeet l'anatomo-pathologie a confirmé un kyste hydatique cérébral dans les deux cas. Les suites ont été favorables. CONCLUSION: Le kyste hydatique cérébral est une affection rare et peu connue au Mali. Une hypertension intracranienne, des signes focaux, des crises convulsives, ainsi que les donnéesTDM et l'IRM sont les clés du diagnostic. La prise en charge neurochirurgicale permet une évolution favorable. La prévention permet l'interruption de la chaîne de transmission.

[Endoscopic surgery and covid 19 disease: case report]. / Chirurgie par voie endoscopique et infection de la maladie a covid 19 a propos d'un cas clinique.

The objective of this work is to raise the issue of contamination of covid 19 disease during endoscopic endonasal surgery for pituitary tumor. This is a 32-year-old patient with a body mass index at 49,38 seen in an outpatient clinic for headache, erectile dysfunction and gynecomania, a CT scan revealed a pituitary macroadenoma. The preoperative workup was unremarkable including the rapid polymerase chain reaction (PCR) test was negative. The endonasal approach was decided for surgery. The tumor was removed by aspiration. The postoperative course was straightforward until the fifth day when the patient presented a dry cough with a fever at 38 ° 5 associated to respiratory discomfort. The thoracic CT-scan showed "ground glass" opacities located at peripheral and bilateral, and essentially posterior suggesting covid 19 disease. A second test was performed. Before the result, the anticoagulant treatment associated with third generation cephalosporin was done. The test results came back after 72 hours and was positive. Azithromycin, hydroxychloroquine, and oral vitamin C have been used for 11 days. The outcome was favorable and the patient was discharged from the hospital on the twelfth day after the negative PCR test.

L'objectif de ce travail est de poser la problématique d'une contamination de la maladie à covid 19 lors L'objectif de ce travail est de poser la problématique d'une contamination de la maladie à covid 19 lors d'une chirurgie endoscopique endonasale pour tumeur hypophysaire. Il s'agissait d'un patient de 32 ans avec un indice de masse corporelle à 49,38 vu en consultation pour céphalées, dysfonctionnement érectile et gynécomanie, la tomodensitométrie avait mis en évidence un macroadénome hypophysaire. Le bilan préopératoire était sans particularité incluant le test rapide « réaction en chaine par Polymérase ¼ (PCR) qui était négatif. La voie endonasale a été décidée pour la chirurgie. La tumeur a été évidée par aspiration. Les suites opératoires ont été simples jusqu'au cinquième jour ou le patient a présenté une toux sèche avec une fièvre à 38°5 associée à une gêne respiratoire. Le scanner thoracique a visualisé des opacités « en verre dépoli ¼ de topographie périphérique et bilatérales et essentiellement postérieure évoquant la maladie à covid 19. Un deuxième test a été effectué.En attendant le résultat le traitement anticoagulant associé à la céphalosporine de troisième génération a été instauré. Les résultats du test sont revenus positifs après 72 heures. L'azithromycine, l'hydroxychloroquine, et la vitamine C par voie orale ont été associées pendent 11 jours. L'évolution a été favorable et le patient est sorti de l'hôpital au douzième jour après la négativité du test PCR de contrôle.

[Cystic meningioma of falx cerebri: About one case and literature review]. / Meningiome kystique de la faux du cerveau : A propos d'un cas clinique et revue de litterature.

Cystic meningioma of the falx is a rare extra-axial tumor, representing 4 to 7% of all intracranial meningioma. We report the case of a 23 years old patient with relative personal health history who has presented for nearly two years generalized headache associated with left hemiparesis. The head CT scan and MRI showed a right posterior parietal tumor with a cystic and fleshy component which was interpreted as glioma. The patient was operated and the intraoperative aspect was an extra axial lesion inserted to the middle tier of the falx cerebri with a clear cleavage plan with the cerebrum. A total ablation of the lesion was down and the histological study confirm the diagnosis. The cystic meningioma is a rare variant of intracerebral meningioma of which only histology makes it possible give the diagnosis of certainty.

Le méningiome kystique de la faux est une tumeur extra-axiale rare, représentant 4 à 7% des méningiomes intracrâniens. Nous rapportons le cas d'une patiente de 23 ans aux antécédents personnels de santé relative qui présentait depuis près de deux ans des céphalées généralisées associées à un déficit de l'hémicorps gauche. Le scanner et l'IRM préopératoire ont montré un processus tumoral pariétal postérieur droit avec une double composante kystique et charnue qui a été interprétée en préopératoire comme gliome. La patiente a été opérée et l'aspect peropératoire était celui d'une lésion extra-axiale insérée aux tiers moyen de la faux du cerveau avec un plan de clivage franc avec le cerveau adjacent. Une exérèse totale de la lésion est réalisée et l'étude histologique a confirmé le diagnostic. Le méningiome kystique est une variante rare de méningiome intracrânien dont seule l'histologie permet de donner le diagnostic de certitude.

[Healthcare associated infections in the neurosurgical department of Gabriel Touré teaching Hospital in Bamako]. / Les infections associees aux soins dans le service de neurochirurgie du CHU Gabriel Toure a Bamako.

INTRODUCTION: Healthcare-associated infections or nosocomial infections are a public health problem due to their frequency, severity and economic impact. They cause an increase of the morbidity, the mortality, the hospital stay and the expenses of taking care of the patients. According to the WHO, 7.1 million people are affected each year, of which about 100,000 die. AIM OF STUDY: The aim of this study was to determine the frequency of healthcare-associated infections in the Neurosurgery Department of Gabriel Touré University teaching Hospital and to identify the risk factors associated with these infections. MATERIAL AND METHODS: This was an epidemiological, descriptive, analytic, cross-sectional and prospective study lasting 6 months from May 29 to November 30, 2016. The study focused on patients who stayed more than 48 hours in the Neurosurgical department Gabriel Touré teaching hospital. The collected data focused on the clinical and biological characteristics of the patients during their hospitalization. The maximum size of the sample was 200 patients. A sample was taken for each type of infection. The criteria used for the diagnosis of Healthcare-associated infections were those of the CDC (Center for Disease Control) and the realization of a thick drop in our context. The chi-square test was used for the comparison of qualitative variables and Kruskal Wallis and Anova for quantitative variables. The materiality threshold has been set to a value of p less than 0.05. RESULTS: At the end of our study, we had 34 infected patients out of 200, a rate of 17%. The significant risk factors found in our study were: high age (p = 0.04), ASA class (p = 0.002), pre-surgical shaving (p = 0.02), long duration surgical intervention (p = 0.002) and long hospital stay (p = 0.004). The types of infections associated with the care found were: urinary in 18 (53%) cases, respiratory in 9 (26%) cases, operative site in 6 (18%) cases and 1 (3%) cases of bacteremia. The bacterial spectrum of these infections was dominated by Negative Gram Bacilli, among which Escherichia coli in 11 (32.3%) cases. The clinical course of patients treated for these infections was marked by healing in 31 (91.2%) cases, complications in 2 (5.9%) cases, and death in 1 (2.9%) case. CONCLUSION: The prevalence of Healthcare-associated infections in our department remains high compared to that found in developed countries. This study allowed us to identify the main risk factors associated with these infections. A stricter adherence to the rules of hygiene and prevention of Healthcare-associated infections is needed to reduce this rate.

INTRODUCTION: Les infections associées aux soins (IAS) ou infections nosocomiales constituent un problème de santé publique par leur fréquence, leur gravité et leur retentissement économique. Elles causent une augmentation de la morbidité, la mortalité, le séjour hospitalier et les frais de prise en charge des malades.Selon l'OMS, 7,1 millions de personnes seraient affectées par les IAS chaque année parmi lesquelles environ 100000 meurent de suites de ces ISA. BUT: Le but de cette étude était de déterminer la fréquence des infections associées aux soins dans le service de Neurochirurgie du CHU Gabriel Touré et d'identifier les facteurs de risque associés à ces infections. MATÉRIEL ET MÉTHODES: Il s'agissait d'une étude prospective d'une durée de 6 mois allant du 29 Mai au 30 Novembre 2016. L'étude a porté sur les patients ayant séjourné plus de 48 heures dans le service de Neurochirurgie du CHU Gabriel Touré.Les données collectées ont porté sur les caractéristiques cliniques et biologiques des patients au cours de leur hospitalisation.La taille maximum de l'échantillon a été de 200 malades. Un prélèvement a été fait pour chaque type d'infection.Les critères utilisés pour le diagnostic de l'IAS étaient ceux du CDC (Center for Disease Control) d'Atlanta ainsi que la réalisation d'une goutte épaisse dans notre contexte.Le test de khi2 a été utilisé pour la comparaison des variables qualitatives et Kruskal Wallis et Anova pour les variables quantitatives. Le seuil de signification a été fixé à une valeur de p inférieure à 0,05. RÉSULTATS: Au terme de notre étude nous avons eu 34 patients infectés sur 200, soit un taux de 17%. Les différents facteurs de risque significatifs retrouvés dans notre étude ont été : l'âge élevé (p=0,04), la classe ASA (p=0,002), le rasage pré-chirurgical (p=0,02), la longue durée de l'intervention chirurgicale (p=0,002) ainsi que la longue durée d'hospitalisation (p=0,004). Les types d'infections associées aux soins retrouvés ont été : urinaires dans 18 (53 %) cas, respiratoires dans 9 (26%) cas, site opératoire dans 6 (18%) cas et 1 (3%) cas de bactériémie. Le spectre bactérien de ces infections était dominé par les Bacilles Gram Négatifs parmi lesquels l'Escherichia coli dans 11 (32,3%) cas.L'évolution clinique des patients traités pour ces infections a été marquée par la guérison dans 31 (91,2%) cas, les complications dans 2 (5,9%) cas et le décès dans 1(2,9%) cas. CONCLUSION: La prévalence des infections associées aux soins dans notre service reste élevée par rapport à celle retrouvée dans les pays développés. Cette étude nous a permis d'identifier les principaux facteurs de risque associés à ces infections. Une observance plus stricte des règles d'hygiène et de prévention des IAS s'impose pour faire baisser ce taux.

Short duration of untreated psychosis enhances negative symptom remission in extended early intervention service for psychosis.

OBJECTIVE: To test whether duration of untreated psychosis (DUP) < 3 months, recommended by the World Health Organization/International Early Psychosis Association, enhances the effects of an extended early intervention service (EEIS) on symptom remission. METHOD: We examined data from a randomized controlled trial in which patients who received 2 years of treatment in EIS for psychosis were subsequently randomized to either 3 years of EEIS or 3 years of regular care (RC). Using a DUP cut-off ≤ 12 weeks (approximately < 3 months), patients were split into two groups. Length of positive, negative and total symptom remission were the outcomes. RESULTS: Patients (N = 217) were mostly male (68%) with schizophrenia spectrum disorder (65%); 108 (50%) received EEIS (58 had DUP ≤12 weeks; 50 had DUP >12 weeks). Interaction between treatment condition (EEIS vs. RC) and DUP cut-off ≤ 12 weeks was only significant in multiple linear regression model examining length of negative symptom remission as the outcome (adjusted ß = 36.88 [SE = 15.88], t = 2.32, P = 0.02). EEIS patients with DUP ≤12 weeks achieved 25 more weeks of negative symptom remission than EEIS patients with DUP >12 weeks. CONCLUSION: Having a short DUP may be critical in deriving long-term benefits from EIS for psychosis, including EEIS settings. This work empirically supports policy recommendations of reducing DUP <3 months.

The Menopause Visual Analogue Scale: a new tool for measuring the severity and response to treatment of symptoms throughout the menopausal transition.

OBJECTIVES: This study aimed to assess the reliability and validity of the Menopause Visual Analogue Scale (MVAS) in measuring symptoms throughout the menopausal transition. METHODS: Two independent samples of women undergoing the menopausal transition completed both the MVAS and the Greene Climacteric Scale (GCS) at a women's mental health clinic between 2008 and 2016. Data for the first sample were obtained using a retrospective chart review of patients seen between 2008 and 2012 (N1 = 75) and data for the second sample came from a prospective study conducted between 2013 and 2016 (N2 = 86). Internal consistency was assessed using Cronbach's α and Pearson's correlation coefficient was used to evaluate concurrent validity. Bland-Altman plots were developed to assess the degree of agreement between the scales. RESULTS: Internal consistency for the physical and psychological domains of the MVAS was 0.80-0.81 and 0.92-0.94, respectively. Pearson's correlations between the MVAS and the GCS were high for both physical (rphys = 0.74-0.76, p < 0.01) and psychological (rpsych = 0.70-0.72, p < 0.01) components in both samples. Changes in MVAS physical and psychological scores in response to treatment were correlated with changes in GCS physical and psychological scores (rphys = 0.69, p < 0.01; rpsych = 0.49, p < 0.01) in the second sample. Bland-Altman plots indicate low to moderate levels of agreement between most portions of the MVAS and the GCS. CONCLUSIONS: These findings suggest that the MVAS has potential for assessing both severity and change in symptoms throughout the menopausal transition, subject to exploring limitations identified in the analysis and application to other populations.

Giant occipital meningohydroencephalocele in an adult: Another historical case in neural tube defects.

Meningohydroencephalocele is a herniation of meninges, cerebrospinal fluid, brain parenchyma and a part of the ventricular system through a bony defect in the skull. This bone defect may be congenital, spontaneous or traumatic in origin. The lesions are mostly congenital, discovered generally after birth or in very young infants. We report the first historical case of the entity in this location in a 29-year-old man and discuss the pathogenesis, surgical management and social considerations of this type of neural tube defect in our country.

Delayed intracerebral and subdural hematomas after ventriculo-peritoneal shunt in a child: A case report and review of the literature.

Ventriculo-peritoneal shunt (VPS) continues to remain the main diverted method to drain the cerebrospinal fluid (CSF) from the ventricles to the peritoneal cavity. It has some complications that must be managed promptly to avoid any eventual fatal evolution. The association of delayed intracerebral and subdural hematomas after VPS insertion is a very rare complication and has, to our knowledge, never previously been reported in the literature. We report a very uncommon association of this entity occurring 11months after a shunt placement in a 13-year-old boy and discuss the likely pathogenesis, as well as the clinical and the radiological data.

[Epidemiological, clinical and therapeutical study of depressed skull fractures in the neurosurgical department of the gabriel toure hospital: about 72 cases]. / Etude epidemiologique, clinique et therapeutique des fractures embarrures du crane a propos de 72 cas dans le service de neurochirurgie du CHU Gabriel Toure.

INTRODUCTION: Depressed skull fractures are common and frequent among neurosurgical diseases of whose danger stem from the associated intracranial lesions. The aims of this study were to describe the epidemiological characteristics of depressed skull fractures, to determine their etiology, to describe the clinical signs, to highlight the complications and sequelae and to evaluate care management. PATIENTS AND METHODS: It was a retrospective and descriptive study from January to December 2013 including 72 patients admitted to the neurosurgical department of the Gabriel Toure hospital. RESULTS: The frequency was 14.7% and the male to female ratio was 13.4. The peak frequency of these injuries occurred in the 16-to 25-year-old age group accounting for 38.9% of cases. Road traffic accidents were the most common causes of depressed skull fractures (59.7%). Neurosurgical treatment was performed in 25 (34.72%) patients and the most common surgical technique performed was the craniectomy in (64%). Infection of the wound was found in 15.3% and the mortality rate was 1.39%. CONCLUSIONS: Depressed skull fractures are a frequent neurosurgical disease in the Gabriel Touré hospital. Young people are most affected and road traffic accidents involving motorbikes are the main cause the fractures. The infection of the wound is a poor prognostic factor. Therefore, an early management is required to expect a good outcome.

INTRODUCTION: Les Fractures embarrures constituent des affections fréquentes en neurochirurgie dont la gravité est liée aux lésions intracrâniennes associées. Les objectifs de ce travail sont les suivants : décrire les caractéristiques épidémiologiques des fractures embarrures du crâne, déterminer les étiologies, décrire les signes cliniques, dégager les complications et les séquelles et évaluer la prise en charge. PATIENTS ET MÉTHODES: il s'agissait d'une étude rétrospective descriptive portant sur 72 malades de janvier à décembre 2013 dans le service de neurochirurgie du CHU Gabriel Touré. La fréquence était de 14,7% avec une forte prédominance masculine (93% des cas). Les jeunes de 16-25 ans étaient les plus touchés soit 38,9%. Les AVP constituaient la principale étiologie avec 59,7% des cas. Le traitement neurochirurgical a été effectué chez 25 patients soit 34,72% et la craniectomie à os perdu était la technique la plus utilisés (64% des cas opérés). L'infection de la plaie a été la complication post opératoire dominante avec 15,3%. le taux de mortalité était de 1,39%.

[Clinical and therapeutical aspects of lumbar stenosis in the gabriel touré hospital: about 24 cases]. / Aspect clinique et therapeutique du canal lombaire a propos de 24 cas enregistres au CHU Gabriel Toure de Bamako.

INTRODUCTION: Lumbar stenosis is a disease caused by a conflict between the neural structures (spinal cord and nerve roots) and spinal structures (bones and ligaments). The objectives of this study were to highlight the frequency, the diagnosis and therapeutics options, and to evaluate the treatment outcomes. PATIENTS AND METHODS: It was a retrospective study from January 2012 to December 2012 including 24 patients admitted to the neurosurgical department of the Gabriel Touré Hospital. RESULTS: The frequency of lumbar stenosis was 6.19% of all neurosurgical diseases. The sex-ratio was 0.71. The age ranged from 28 to 81 years with an average of 52 years. The neurogenic claudication was found in 87.5%. The straight leg raising test was positive in 41.7% of cases. The most vertebras involved were L4 and L5. Lumbar disc herniation was associated in 70.83%. Degenerative lumbar stenosis was the most common form, found in 66.67% of cases. Surgical treatment was performed in 29.17% of cases. The outcome was good in 85.6% of cases. CONCLUSIONS: Lumbar stenosis is a prevalent disease that occurs typically occurs around 50 years of age. The diagnosis was confirmed by myelography and a post myelographic CT scan. Good outcomes are achieved with both surgical or medical treatments.

INTRODUCTION: Le canal lombaire étroit (C.L.E.) est une pathologie liée à un conflit entre le contenant (ostéo-discoligamentaire) et le contenu (moelle épinière et ses composantes). Les objectifs de ce travail étaient de déterminer la fréquence du CLE, de déterminer les méthodes de diagnostic et de traitement, d'évaluer les résultats du traitement. PATIENTS ET MÉTHODE: Il s'agissait d'une étude rétrospective portant sur 24 cas de canal lombaire étroit colligés entre le 1er Janvier 2012 et le 31 Décembre 2012% dans le service de Neurochirurgie du C.H.U Gabriel Touré. RÉSULTATS: le CLE constitue 6,19% de nos patients opérés. Le sexe féminin prédominait avec 58%. L'âge moyen était 52 ans avec les extrêmes de 28 ans et de 81 ans. La claudication était retrouvée à l'interrogatoire chez 87,5% des cas. le signe de Sonnette était retrouvé chez 41,7% des patients. Les vertèbres L4 et L5 étaient les plus touchés. La hernie discale était associée dans 70 .83%. Le CLE acquis représentait 66,67% des cas, la forme constitutionnelle,25% et celle congénitale, 8,33%. Le traitement a été médical dans 70,83% des cas et chirurgical 29,17%. Les résultats étaient bons dans 85,6%. CONCLUSION: le CLE est une affection fréquente se manifestant vers l'âge de 50 ans. La confirmation du diagnostic était faite par la saccoradiculographie couplée au myéloscanner. Le traitement médical ou chirurgical donne des bons résultats.

Etude epidemiologique; clinique et therapeutique des fractures embarrures du crane a propos de 72 cas dans le service de neurochirurgie du CHU Gabriel Toure

Introduction : Les fractures embarrures constituent des affections frequentes en neurochirurgie dont la gravite est liee aux lesions intracraniennes associees. Les objectifs de ce travail sont les suivants : decrire les caracteristiques epidemiologiques des fractures embarrures du crane; determiner les etiologies; decrire les signes cliniques; degager les complications et les sequelles et evaluer la prise en charge. Patients et Methodes : il s'agissait d'une etude retrospective descriptive portant sur 72 malades de janvier a decembre 2013 dans le service de neurochirurgie du CHU Gabriel Toure. La frequence etait de 14;7% avec une forte predominance masculine (93% des cas). Les jeunes de 16-25 ans etaient les plus touches soit 38;9%. Les AVP constituaient la principale etiologie avec 59;7% des cas. Le traitement neurochirurgical a ete effectue chez 25 patients soit 34;72% et la craniectomie a os perdu etait la technique la plus utilises (64% des cas operes). L'infection de la plaie a ete la complication post operatoire dominante avec 15;3%. le taux de mortalite etait de 1;39%

Dracunculiasis in Cameroon at the threshold of elimination.

BACKGROUND: Dracunculiasis is endemic in Mayo Sava Division in the Far North Province of Cameroon. Transmission occurs during the rainy season with a peak in the months of July and August. METHODS: A combination of interventions consisting of active surveillance, social mobilization, health education, distribution of filters, construction of new water sources, chemical treatment of unsafe water sources with temephos, and case containment were applied in Mayo Sava in 1990-1995 by the national Guinea Worm Elimination Programme (GWEP). Dracunculiasis cases were detected by village health workers, confirmed by health outreach teams and reported weekly to the GWEP. RESULTS: A decline in the incidence of dracunculiasis by 98.1% from 778 cases in 1990 to 15 in 1995, and in the number of endemic villages by 92.7% from 82 in 1990 to 6 in 1995 was achieved. The proportion of cases identified < or =24 hours of worm emergence increased from 19% in 1991 to 73.6% in 1993. Over 1500 nylon monofilament filters were distributed yearly to endemic villages lacking safe drinking water sources, while 81 new water sources were constructed (boreholes, wells and dikes), 55% in 1992-1993. The success of GWEP is attributed mainly to: intensive and simultaneous implementation of interventions in highly endemic villages in the first 3 years of the programme, case containment, and cash reward. CONCLUSIONS: Cameroon is on the threshold of eliminating dracunculiasis from Mayo Sava but the major remaining obstacle is the ever increasing threat of re-infestation from neighbouring countries.

PIP: Dracunculiasis is endemic in Mayo Sava Division, Far North Province, Cameroon, with transmission occurring during the rainy season with a peak during July-August. Interventions applied against the disease in the division in 1990-95 by the national Guinea Worm Elimination Program (GWEP) include active case surveillance, social mobilization, health education, filter distribution, the construction of new water sources, chemical treatment of unsafe water sources with temephos, and case containment. Dracunculiasis cases were detected by village health workers, confirmed by health outreach teams, and reported weekly to the GWEP. The incidence of dracunculiasis declined by 98.1% from 778 cases in 1990 to 15 in 1995, while the number of endemic villages declined by 92.7% from 82 to 6 over the period. The proportion of cases identified within 24 hours of worm emergence increased from 19% in 1991 to 73.6% in 1993. More than 1500 nylon monofilament filters were distributed yearly to endemic villages lacking safe drinking water sources, while 81 new water sources were built. Potential reinfestation from neighboring countries threatens Cameroon's efforts to eliminate dracunculiasis from Mayo Sava.

A retrospective six-months clinical trial of adhesive precoated brackets and bonding system.

This study investigated bond failures in two groups of 75 patients. Either adhesive precoated (APC) or control brackets were bonded from bicuspid to bicuspid in the mandibular and maxillary arch by a single experienced operator. Observations on failure were recorded at initial arch wire insertion and for the first six months of treatment. The APC bracket failed significantly more often than the control at initial arch wire insertion in both maxillary and mandibular teeth. Further examination disclosed that the APC bracket, when bonded to mandibular teeth, also failed significantly more often than the control during the subsequent six months of treatment. At the six-month point of the study, a total of 53 bond failures had occurred at 671 bond sites in the APC group (7.89 per cent failure rate), compared to 27 bond failures at 977 bond sites in the control group (2.76 per cent failure rate). Fourteen patients in the APC group and two patients in the control group experienced bond failure at initial arch wire insertion. Twenty-eight patients in the APC group and 13 in the control group experienced bond failures within the first six months following initial arch wire insertion.

Cameroon: an African model for final stages of guinea worm eradication.

The Cameroon Guinea worm eradication program initiated case containment activities in 1991 in the Mayo-Sava Division, the only endemic region in the country. These activities differed from the Pakistan program, the only other operational model for dracunculiasis case containment, in two important ways. In Cameroon, next-level supervisors received reports of new cases from village health workers during routine weekly visits to endemic villages. The Pakistan program established a faster case reporting scheme that allowed higher level personnel (sector supervisors and regional managers) to confirm cases within one week of worm emergence. Second, in Cameroon case containment activities were extended only to villages reporting five or more cases the previous transmission season and villages with recent confirmed cases. In Pakistan, all villages reporting cases during the previous year were included in the program. A village-by-village case search one year after initiation of case containment in the Mayo-Sava indicated decreases of 60% in the number of cases and 51% in the number of villages reporting cases. Based on the apparent success of the efforts in Cameroon, we propose a two-stage scheme for implementation of case containment. Both stages are based on rapid detection and containment of cases, within 24 hr of worm emergence, by village-based health workers. In stage 1, cases are reported and confirmed during routine weekly visits to the endemic villages by next-level supervisors. Weekly reporting should be extended to all villages with recent confirmed cases and to as many villages reporting cases during the previous transmission season as logistically possible.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation de la couverture vaccinale du Departement du Mayo-Sava; Province de l'Extreme-Nord; Cameroun; Fevrier 1993

Une enquete de couverture vaccinale a ete menee dans le Departement du Mayo-Sava du 9 au 20 fevrier 1993. Elle a concerne 209 enfants; les deux sexes confondus. Les resultats de cette enquete sont presentes sous trois formes a savoir la couverture avec histoire; la couverture brute et la couverture corrigee. Bien que les objectifs du Programme elargi de vaccination ne soient pas totalement atteints; d'indeniables progres ont ete cependant realises dans le Departement du Mayo-Sava

La dracunculose au Cameroun en 1991

La dracunculose; qui sevit dans le Departement du Mayo-Sava (Province de l'Extreme-Nord) au Cameroun; a vu son incidence reduite de la moitie entre 1990 et 1991 passant de 778 a 394 cas grace aux mesures prises dans la cadre du programme national d'eridication

Impact de la dracunculose sur la production agricole dans le Mayo-Sava; Cameroun

Jusqu'a ce jour le departement du Mayo-Sava (Cameroun) est le seul foyer confirme de dracunculose au Cameroun ou entre 800 et 900 cas sont signales chaque annee. Une etude socio-economique montre une perte en production agricole de 343 kg par an et par cas pour le mil et 205 kg pour le coton soit un total de 100 tonnes de coton et 300 tonnes de mil perdus chaque annee