The Usefulness of International Cooperation in the Repair of Inguinal Hernias in Sub-Saharan Africa.

INTRODUCTION: The burden of disease and mortality associated with inguinal hernia in Africa, especially in sub-Saharan Africa, is very high. The purpose of this study is to show that International Cooperation work in the field of hernia repair is effective; it minimizes the delay in hernia repairs in the targeted population, and can prevent a large number of disability-adjusted life years (DALYs). MATERIALS AND METHODS: As a part of an International Cooperation program, a total of 990 black patients with inguinal hernias were studied, in whom hernioplasty was performed using polypropylene mesh. The type of hernia and surgical technique were studied. Indicators of scientific and technical quality, indicators of efficiency and of effectiveness were analyzed. The results on the usefulness of interventions were calculated as avoided DALYs. RESULTS: Surgery was performed on 926 patients with a total of 1033 hernia repairs. 87.2 % of the repairs were made with mesh. There was no mortality in the series, complications were minor, and 85.7 % of patients remained less than 24 h in the center. There was a 2.8 % of recurrence, with a follow-up 58.7 % of the patients in the first year. 5014 DALYs were avoided, and the average of the avoided DALYs per patient was of 5.41. CONCLUSIONS: Hernia repair with mesh in low development countries is a procedure with low morbidity and high effectiveness that can prevent a large number of DALYs.

[Infections and systemic lupus erythematosus. Analysis of risk factors and prognosis. A prospective study (1979-1988)]. / Infecciones y lupus eritematoso sistémico. Análisis de factores de riesgo y pronóstico. Estudio prospectivo (1979-1988).

We have prospectively studied 48 patients previously diagnosed of systemic lupus erythematosus over a mean follow up period of 5.8 years of which 28 presented 36 episodes of infection and 20 did not develop infections. Urinary infections were the most frequent kind of infection followed by pneumonia and bacteriemia; the most frequently isolated microorganism responsible for those infections were E. colii, staphylococcus aureu and P. mirabillis. We have found a risk factors that and impared renal function an steroid treatment over 20 mg/day were significantly associated with a increasing number of infectious precesses. On the contrary, we have observed that only a bad and critical clinical situation had prognostic value and was significantly associated with an increased mortality.