Is recipient's body mass index a determinant of short term complications in early renal transplantation?

OBJECTIVES: Obesity prevalence has increased over the past 20 years in the general population and among kidney transplant recipients. General surgical belief is that obesity increases surgical difficulty. The aim of this study was to assess the impact of Body Mass Index (BMI) on perioperative complications. METHODS: All kidney transplantations performed in adults in our centre from 2006 to 2011 were analysed. Data on patients' characteristics, surgical protocol, intra and postoperative complications and renal function were collected. Patients were divided into 4 groups as follows: underweight (BMI<18.5kg/m2), normal weight (18.5kg/m2≤BMI<25kg/m2), overweight (25kg/m2≤BMI<30kg/m2) and obese (BMI≥30kg/m2). We also studied the impact of BMI on complications using it as a continuous variable to identify potential threshold values. RESULTS: Among 694 patients included, 52% had normal BMI, 7%, 31% and 9% were underweight, overweight and obese, respectively. In multivariate analysis, overweight was significantly associated with longer operative time compared to normal-weight patients (estimated mean difference of 10,4min, 95% confidence interval (CI) [4.0; 16.9]) and obesity was associated with an increased risk of wound dehiscence (odds ratio 3.1, 95%CI [1.3; 7.3] compared with normal-weight patients). Considering BMI as a continuous variable, the risk of parietal dehiscence significantly increased beyond a BMI of 26kg/m2, intraoperative blood loss and the risk of ureteral stenosis beyond 32kg/m2 and the risk of abdominal wall hematoma beyond a BMI of 34kg/m2. CONCLUSIONS: We found BMI thresholds above which intraoperative blood loss and the risk of parietal dehiscence, ureteral stenosis, and parietal hematoma significantly increased. LEVEL OF EVIDENCE: 3.

Inhospital outcome of elderly patients in an intensive care unit in a Sub-Saharan hospital.

BACKGROUND: In Burkina Faso, demographics are changing and we are seeing a growing prevalence of older patients in intensive care units. Elderly people have increased health care needs but there is a lack of geriatric specialists. This study aimed to analyze in-hospital outcome of patients aged over 65 years, admitted to the Intensive Care Unit (ICU) at Yalgado Hospital. METHODS: We carried out a 5-year retrospective study in the ICU of Yalgado Ouédraogo Hospital. Elderly patients with completed records were included. Baseline characteristics, clinical and outcome were analyzed. RESULTS: Two thousand one hundred sixteen patients were admitted to ICU, 237 (11.2%) of whom were included. There were 70 females and 167 males. The median age was 71.7 ± 6.1 years. The overall mortality rate in ICU was 73%, of whom 90% died within 7 days after admission. In multivariate analysis, shock (Odds Ratio: OR = 2.2, p = 0.002), severe brain trauma (OR; 9.6, p = 0.002), coma (OR 5.8 p < 0.003), surgical condition (OR = 4.2, p = 0.003), ASAPS Score ≥ 8 (OR = 4.3, p = 0.001), complication occurring (OR = 5.2, p = 0.001) and stroke (OR = 3.7, p = 0.001) were independent factors. CONCLUSION: Elderly patients were frequent in ICU and their mortality rate was high. Stroke, severe brain trauma, surgery, complications occurring during hospitalization were independent risk factors of death.

Complications aigues métaboliques du diabète sucré dans le Service de Réanimation Polyvalente du Centre Hospitalier Universitaire Yalgado Ouédraogo de Ouagadougou au Burkina Faso

Objectif : Etudier les complications aiguës métaboliques (CAM) du diabète sucré dans le Service de Réanimation Polyvalente (SRP) du Centre Hospitalier Universitaire Yalgado Ouédraogo (CHU-YO) au Burkina Faso.Patients et méthodes : Etude rétrospective sur une période de cinq ans (1erjanvier 2008 au 31 décembre 2012). La population d'étude était constituée des patients admis dans ledit service pour une CAM du diabète sucré. Résultats :Soixante-six patients ont été retenus pour l'étude.La fréquence d'admission pour des CAM de diabète était de 6,5% avec un âge moyen de 55 ± 17 ans et une prédominance masculine (sex-ratio=1 ,06). Les principaux motifs d'admission étaient lecoma grave (62,1%), détresse respiratoire (81,8%) et déshydratation (15,1%).La mauvaise observance thérapeutique était retrouvée dans 64,5%.L'acidocétose constituait 59,1% des CAM suivie de l'hypoglycémie (27,3%) et du syndrome d'hyperglycémie hyperosmolaire(SHH) (13,6%). L'hyperglycémie moyenne était de 26, 31 mmol/L et l'hypoglycémie moyenne de 1,3 ± 0,7 mmol/L. Une cétonurie (69,1%) et une glycosurie (67,8%) étaient observées. Les complications étaient associées à un âge avancé (p= 0.003).L'infection constituait le principal facteur de décompensation. La durée moyenne de séjour était 5,8 ± 5,6 jours.La mortalité globale (54,55%) était liée à la gravité du coma (p=0,007).Conclusion : Les CAM du diabète sucré sont relativement fréquentes dans le SRP du CHU-YO à Ouagadougou. Le taux de mortalité est élevé. Une prise en charge précoce et adaptée pourrait améliorer le pronostic vital

[Epidemiology of neonatal surgical emergencies in Ouagadougou]. / Épidémiologie des urgences chirurgicales néonatales à Ouagadougou.

OBJECTIVE: The purpose of this study was to determine the rate of neonatal surgery emergencies and to highlight the main causes and difficulties related to better handling of these emergencies. PATIENTS AND METHODS: We conducted a 1-year descriptive prospective study from September 2009 to September 2010 based on 102 cases collected. At admission, we studied the patients' age, the pathologies encountered, the related malformations, the terms for better management, and prognosis. FINDINGS: In 1 year, we registered 102 cases of neonatal surgical emergencies affecting the digestive tract (63.7%), the anterior side of the abdomen (24.5%), trauma (6.7%), and tumors (2%). Males comprised 60.8% of the cases. The sex-ratio was 1.55. The frequency of such cases was 3.94%. The average age of patients was 5 days with the 0- to 5-day-old age group presenting most frequently. The average hospitalization lasted 2.75 days and the admission method was the reference in 75.5%. Congenital pathology accounted for 95.5% of cases with anorectal malformations (ARM) (35; 95%) and omphaloceles (28.1%). Hirschsprung disease was the main cause of bowel obstruction other than ARM (50%). The average time to surgery was about 2.54 days. The overall mortality of neonatal surgical emergencies was 30.3% and postoperative mortality 32.35%. The late consultation, poverty, a shortage of qualified staff, prematurity, low birth weight, congenital disease, and related malformations were the leading factors of a poor prognosis. Acquisition of effective technical means, staff training, measures to combat poverty, and better prenatal care would improve the management of neonatal surgical emergencies. CONCLUSION: Neonatal surgical emergencies include conditions that require immediate and adequate support. The continuous training of healthcare workers at all levels in the detection of neonatal emergencies and equipping healthcare facilities are an absolute necessity to provide better management and reduce the mortality rate.

[Assessment of knowledge and pain management by traumatological emergencies staff of the teaching hospital of Ouagadougou]. / Evaluation des connaissances et pratiques du personnel des urgences traumatologiques de Ouagadougou sur la prise en charge de la douleur.

INTRODUCTION: Pain is a frequent reason of consultation in traumatological emergencies. Its management is characterized by oligoanalgesia whose causes are multiple. The purpose of this study is to assess the knowledge and practices of pain management by traumatological emergencies staff of the teaching hospital Yalgado Ouedraogo of Ouagadougou. MATERIALS AND METHODS: A questionnaire survey of health workers performing in traumatological emergencies has been conducted. Two different questionnaires, one for medical staff and one for the paramedics were administered. RESULTS: A total of 67 health workers participated in the study with a participation rate of 98% and 100%, respectively, for the medical and paramedical staff. According to their report, 65.3% of medical and 77.7% of paramedical staff had never received training on pain and its management. For 85.7% of physicians, pain should be assessed before treatment, but 79.6% of them didn't know any conventional pain assessment method. All the nurses and 40.8% of physicians felt that pain in the emergency services should not be treated immediately to prevent misdiagnosis. Morphine and regional anesthesia were not used for pain treatment in the emergency room. 10.2% of medical staff and 27.8% of the paramedics said that they systematically search for the analgesicsside effects. CONCLUSION: The knowledge of health workers about pain and its management is insufficient. The lack of training of health workers on the management of pain is the cause and contributes to explain the oligoanalgesia in this service.

INTRODUCTION: La douleur est un motif fréquent de consultation aux urgences traumatologiques. Sa prise en charge est caractérisée par une oligoanalgésie dont les causes sont multiples. Le but de cette étude est d'évaluer les connaissances et pratiques du personnel des urgences traumatologiques du Centre hospitalier universitaire Yalgado Ouédraogo de Ouagadougou sur la prise en charge de la douleur. MATÉRIEL ET MÉTHODE: Une enquête par questionnaire auprès du personnel de santé exerçant aux urgences traumatologiques a été menée. Deux questionnaires différents, l'un pour le personnel médical et l'autre pour le personnel paramédical ont été administrés. RÉSULTATS: Au total, 67 agents de santé ont participé à l'étude avec un taux de participation de 98% et 100% respectivement pour le personnel médical et paramédical. Selon leur déclaration, 65,3% du personnel médical et 77,7% du personnel paramédicaux n'avaient jamais bénéficié de formation sur la douleur et sa prise en charge. Pour 85,7% des médecins, la douleur devrait être évaluée avant traitement mais 79,6% d'entre eux ne connaissaient aucune méthode conventionnelle d'évaluation de la douleur. L'ensemble des infirmiers et 40,8% des médecins estimaient que la douleur aux urgences ne devrait pas être traitée d'emblée afin d'éviter des erreurs diagnostiques. La morphine et l'anesthésie locorégionale n'étaient pas utilisées aux urgences pour traiter la douleur. 10,2% du personnel médical et 27,8% du personnel paramédical ont affirmé rechercher systématiquement les effets secondaires des antalgiques. CONCLUSION: Les connaissances des agents de santé sur la douleur et sa prise en charge sont insuffisantes. L'absence de formation du personnel de santé en algologie en est la cause et contribue à expliquer l'oligoanalgésie observée dans ce service.

[Acute intestinal obstruction]. / Occlusion intestinale aiguë.

A 12-year-old boy is admitted for emergency surgery for acute abdominal syndrome. The intervention showed strangulation of the terminal ileum by the vermiform appendix. The pathology analysis showed bilharzial appendicitis by Schistosoma haematobium. The patient was treated with praziquantel. The literature is not plentiful on this subject. Because protozoiasis is endemic in this area, it should be looked for in all cases of appendicitis, as it requires medical treatment in addition to the appendectomy.

[Prognosis for motor deficits after strokes in Burkina Faso]. / Pronostic du handicap moteur au cours des accidents vasculaires cérébraux au Burkina Faso.

Stroke is a common, severe, and disabling condition that is recognized as a major public health problem. Our goal was to study the clinical features and prognosis of motor deficits in stroke patients hospitalized in the neurology department of the Yalgado-Oeudraogo University Hospital in Burkina Faso. This cross-sectional study took place from March 1 through September 30, 2012. The study included all patients with motor disabilities following a CT-confirmed stroke that had occurred within the previous month. Patients were reviewed at one month (M1) and three months (M3) to assess their current treatment and their autonomy, by the Barthel Index. During the study period, 59 patients were hospitalized for stroke, 56 with motor disabilities for a 95% prevalence of stroke with motor deficit. Their mean age was 57.8 ± 17.7 years (range: 20 to 84 years), and the sex-ratio of 1.6 (male/female). Overall, 61% of the strokes were ischemic and 39% hemorrhagic, with an equal distribution of right and left hemiplegia (46.4% each) and 7% of the patients showing bilateral involvement. The mortality rate before M1 was 29% and before M3, 40%. On admission, 4% of patients had a Barthel Index greater than 60, at M1 35%, and at M3, 60%. Only 51% of patients received physical therapy. Characteristics significantly associated with functional recovery were age younger than 65 years (p = 0.0026), sphincter disorders at M1 (p = 0.002), hemorrhagic stroke (compared to ischemic) (p = 0.0038), functional rehabilitation (p = 0.0012), and right (versus left) hemisphere damage (p = 0.010).

POEMS syndrome with prominent acute axonal lesions.

Polyneuropathy is a common presenting component of POEMS syndrome whose symptoms are attributed to an overproduction of vascular endothelial growth factor (VEGF). We report two female patients with POEMS syndrome presenting as a severe predominantly axonal neuropathy. A nerve biopsy was performed for these patients; pathological data confirmed unusual numerous acute axonal lesions associated with other classical signs of POEMS syndrome. POEMS syndrome is usually associated with demyelinating neuropathy (and secondary axonal loss); however, prominent axonal neuropathy (with acute axonal lesions on nerve biopsy) can also be observed in this disease. These observations illustrate the heterogeneity of peripheral nervous system involvement in POEMS syndrome.

[Morgagni hernia: Concerning 2 pediatric cases in Sub-Saharan Africa]. / Hernie de morgagni: a propos de deux cas pediatriques en Afrique Sub Saharienne.

Morgagni hernias are uncommon diaphragmatic hernias that are generally asymptomatic, and so far, very limited data is available about them. We report two cases of repaired successfully Morgagni hernias using a transabdominal approach. The aim of this study is to illustrate the diagnostic difficulties and the excellent post operational prognostic observed following the transabdominal procedure. Both patients were female, one 8 months old and the other 3 months old. The presenting symptom was recurrent chest infection. Chest x-rays were carried out on both patients, which showed a pre-cardiac gas mass. A transabdominal surgical approach enabled surgeons to sow the defect with non resorbable suture material in one patient, and a prolene plate in the other. The patients fully recovered and no postoperative difficulties were reported.

La hernie de Morgagni ou hernie diaphragmatique congénitale antérieure est une entité peu décrite dans la littérature et est le plus souvent asymptomatique. Le but de cette étude est d'illustrer les difficultés diagnostiques et l'excellent pronostic après traitement chirurgical après abord trans abdominal sus ombilical de cette forme rare de hernie des coupoles diaphragmatiques. Nous rapportons deux cas simulant une pneumopathie chronique chez deux nourrissons de sexe féminin âgés respectivement de 8 mois et 3 mois. Les radiographies pulmonaires de face et de profil ont permis de poser le diagnostic par la mise en évidence d'une clarté gazeuse pré cardiaque. La laparotomie transversale sus ombilicale a permis la fermeture du défect par suture avec du fil non résorbable chez une patiente et une obturation à l'aide d'une plaque de prolène chez la deuxième patiente. Les suites opératoires ont été simples.

Hirschsprung's disease: management problem in a developing country.

BACKGROUND: The management of Hirschsprung's disease remains a problem in developing countries. Our aim is to identify the main epidemiological, clinical, and therapeutic characteristics of Hirschsprung's disease at the University Child Hospital Charles De Gaulle of Ouagadougou (CHUP-CDG). PATIENTS AND METHOD: It is a retrospective study carried out in the period from January 2001 to December 2007 in the Surgery Unit at CHUP-CDG, which is a reference centre for Paediatric Surgery in Burkina Faso. RESULTS: There were 52 patients (M: F=3.3:1). The annual incidence was seven cases. Age at presentation and diagnosis ranged from two days 10 years (median 20 months). Twenty five patients were from poor socio-economic conditions. Presentations were mainly intestinal obstruction, chronic constipation and enterocolitis. There were two cases of associated trisomy 21. Average age at operative intervention was 3.17 months. The rectosigmoidal form was the most frequently encountered. Over two-thirds (67.31%), with no complications at presentation, had benefited from nursing before their final treatment. A temporary colostomy was requested in case of complication. Swenson's technique was practiced for all the patients who underwent surgery operation. The assessment of functional results in eight patients after an average decrease of 3.5 years gave excellent results. Post-surgery complications were mainly enterocolitis in 12% of patients. Mortality rate was 16%. CONCLUSION: Management of Hirschsprung's disease is a problem in Burkina Faso. It is characterised by its late presentation and difficult diagnosis due to inaccessibility and the non-availability of some investigation services (barium enema, histochemistry, and histology), resulting in high morbidity and mortality rates. Effective technical capacities, adequate staff training, and public education will be necessary to improve care quality.

[Management of stroke in sub-Saharan Africa: current issues]. / Prise en charge des accidents vasculaires cérébraux en Afrique subsaharienne.

In sub-Saharan Africa, stroke is likely to present an increasingly important public health problem with a larger relative share of overall morbidity and mortality. Overall, sub-Saharan Health Care is characterized by a lack of human resources, lack of facilities for special investigations, and especially an absence of specific programs addressing the prevention of cardiovascular conditions. Current data on the epidemiology of stroke in sub-Saharan Africa, although sparse and fragmentary, indicate a comparatively high incidence of cerebral hemorrhage associated with high blood pressure, while ischemic stroke in black Africans still appears to be related primarily to small artery disease, HIV infection, and sickle cell disease. With urbanization, the role of large-vessel atherosclerosis is increasing. It is thus essential to coordinate government funding, health care professionals and development agencies to address this rising health problem. Access to health care needs to be better structured, and screening programs should be developed in order to identify and treat vascular risk factors. Improved training of health care professionals is also required in the areas of prevention, diagnosis and management of stroke. Implementation of best-practice recommendations for the management of stroke adapted to the specificities and resources of African countries would help rationalize the scarce resources currently available.

[Strangulated umbilical hernia in children (Burkina Faso): differences with developed countries]. / Hernies ombilicales étranglées chez l'enfant au Burkina Faso: différences avec les pays développés.

Umbilical hernias occur frequently in children but complications are rarely reported. This study assesses the incidence of complicated umbilical hernias in our patients, evaluates data for risk factors, and shows dissimilarities with those encountered in developed countries. This study reports all children operated for complications due to strangulated umbilical hernia over a period of 3 years. On the whole, 162 children had umbilical hernias treated during this period. Thirty (18.5%) of these had complicated hernias. The average age of the complicated group was 3(1/2) years. Twenty-nine cases had a painful irreducible umbilical mass. Twenty-four children had bowel obstruction, while stercoral fistula occurred in one child. The average diameter of the hernia ranged between 1 and 1.5 cm. Five patients had ischemic intestine that required resection. One patient died. When active observation and follow-up after 1 year is difficult or not feasible when the wall defect diameter is 1.5 cm or less, and in suspicion of incarceration (unexplained abdominal pain, and irreducibility), umbilical hernia should be operated.

[Contribution of corticosteroid to the treatment of pain in the acute phase of Guillain-Barré syndrome]. / Interêt de la corticothérapie dans le traitement de la douleur à la phase aiguë du syndrome de Guillain-Barré.

INTRODUCTION: Pain is a common problem in both adults and children with Guillain-Barré Syndrome (GBS). Corticosteroids are rarely used in the treatment of pain in the course of GBS, although some authors have pointed out their value for the treatment of neuropathic pain. We report four patients with GBS whose pain was rapidly relieved by administration of corticosteroids. METHODS: We reviewed retrospectively a series of four patients with GBS seen from September 2001 to February 2003. All patients had plexual (Case 3), trunkular (case 1), radicular (case 2) or focal (case 4) pain. Pain was treated with corticosteroids via oral (cases 1 and 2) or intravenous routes (cases 3 and 4). Corticoids where used after failure of other analgesic agents. RESULTS: Pain relief was obtained after the first administration and persisted even after tapering off steroid treatment. No particular complication was observed during treatment course. CONCLUSION: Our experience suggests that controlled studies should be set up to evaluate the place of corticosteroid treatment for the management of pain in patients with GBS.

Atypical electrophysiologic findings in chronic inflammatory demyelinating polyneuropathy (CIDP)--diagnosis confirmed by nerve biopsy.

OBJECTIVES: Numerous sets of electrophysiological criteria of chronic inflammatory demyelinating polyneuropathy (CIDP) have been proposed, among which the criteria established by an ad hoc subcommittee of the American Academy of Neurology (AAN) in 1991 (Neurology 41 (1991) 617) are the most widely used. As they seemed rather restrictive, the Inflammatory Neuropathy Cause and Treatment (INCAT) group (Ann. Neurol. 50 (2001) 195) proposed modifications of these electrophysiological criteria. However, even using these criteria, some cases of CIDP may not be recognized. In such cases, nerve biopsy has proven useful for confirmation of the diagnosis by demonstrating specific abnormalities. The objective of the study was to determine the profile of electrophysiological abnormalities in patients with atypical electrophysiologic criteria of CIDP and the diagnostic value of multiple A waves and a low median to sural amplitude ratio. PATIENTS AND METHODS: Over a period of 3 years, we classified 44 patients into two categories: those presenting the strict AAN and/or INCAT criteria and those who we regarded as cases of CIDP not meeting these criteria. All patients benefited from one or more clinical and electrophysiological examination. Extensive biological workup and genetic study when appropriate excluded other causes of neuropathy. Nerve biopsies were taken from all patients and samples were included in paraffin and epon for systematic light, teasing and electron microscopic examination. RESULTS AND CONCLUSION: Out of 44 patients, 36 fulfilled the INCAT or AAN criteria. In eight other patients, the diagnosis of CIDP was suspected on clinical and EMG examinations and confirmed by nerve biopsy. In these cases, the electrophysiological exploration showed some abnormalities such as multiple A waves in four out of eight patients or an abnormal pattern of the sensory responses of the median and sural nerves in four out of eight patients that were more indicative of an initial demyelinating process. Six of our patients received immunomodulatory treatment, and five responded favorably.