ABSTRACT
BACKGROUND: Variceal upper gastrointestinal bleeding is a dreadful complication of portal hypertension with a significant morbidity and mortality. Different prognostic scores can be used. However, in the local context of Madagascar, the completion of paraclinical investigations can be delayed by the limited financial means of patients. Hence, determining clinical mortality risk factors of variceal upper gastrointestinal bleeding could be interesting. The aim of the study was to evaluate the clinical mortality risk factors of variceal gastrointestinal bleeding (VUGIB). METHOD: An observational, cohort retrospective study was conducted over an 8-year period (2010-2017), at the surgical intensive care unit of the J.R. Andrianavalona University Hospital, Antananarivo, in patients admitted for VUGIB confirmed by upper gastrointestinal endoscopy and whose clinical examination was performed at admission. The primary endpoint was intensive care unit (ICU) mortality. Univariate analysis and multivariate logistic regression analysis were performed to identify risk factors for ICU mortality, with OR defining odds ratio. A p value <0.05 was considered significant. RESULTS: 1920 patients were admitted for gastrointestinal bleeding of any digestive causes; the source of bleeding was variceal in 269 patients (14%). The predominantly male population (sex ratio = 2.5), aged 47.1 ± 13.7 years was mostly American Society of Anesthesiologists (ASA) 1 classification (58.4%). In 56.5% of patients, the gastrointestinal bleeding had not occurred before. The mortality rate was 16.0%. Three major clinical factors of mortality were identified: previous endoscopic band variceal ligation (OR = 12.57 [2.18-72.58], p = 0.005), tachycardia >120 bpm (OR = 2.91 [1.04-8.14], p = 0.041), and ascites (OR = 3.80 [1.85-7.81], p < 0.001). CONCLUSION: Upper gastrointestinal bleeding may be life-threatening. The mortality scores are certainly useful; however, the identification of clinical factors is interesting in countries like Madagascar, pending the results of paraclinical investigations.
ABSTRACT
OBJECTIVE: The aim of this study was to present the first cases of spinal anesthesia, in newborns and infants, preterm/ex-prematures, in order to determine its feasibility and its potential harmlessness, in Antananarivo-Madagascar. Indeed, spinal anesthesia is a low cost technique and can limit respiratory complications, postoperative apnea a contrario with pediatric general anesthesia which can lead to perioperative risks. RESULTS: In a retrospective, descriptive, 7-year (2013 to 2019) period study, conducted in the University Hospital Joseph Ravoahangy Andrianavalona, 69 patients' data files planned to have spinal anesthesia were recorded. These pediatric patients were predominantly male (sex ratio = 2.8) and 37 [28-52] days old. The smallest anesthetized child weighed 880 g; the youngest was 4 days old. Twenty-seven (27) of them were premature and 20.3% presented respiratory diseases. They were mostly scheduled for hernia repair (90%). Spinal anesthesia was performed, with a Gauge 25 Quincke spinal needle, after 2 [1-2] attempts with hyperbaric bupivacaine of 4 [3.5-4] mg. Failure rate was 5.8%. The heart rate was stable throughout perioperative period and no complications were observed.
Subject(s)
Anesthesia, Spinal , Apnea/epidemiology , Child , Herniorrhaphy , Humans , Infant , Infant, Newborn , Madagascar , Male , Retrospective StudiesABSTRACT
BACKGROUND: Periportal fibrosis is one of the major complications of schistosomiasis infection. Specific images of this infection revealed by ultrasonography allow the assessment of the different stages. Our purpose is to describe the ultrasonographic appearances of periportal fibrosis due to schistosomiasis infection. METHODS: The study was retrospective descriptive in the Medical Imagery Centre of CHUJRA. RESULTS: A total of 29 patients showed upper and/or lower digestive hemorrhage and a positive result in schistosomiasis serology. The median age was 41.2 years. Male gender dominated with 54.7%. In 78.3% of the cases, the patients were farmers in schistosomiasis-endemic areas. On ultrasonography, 81.3% were found to present Stage III periportal fibrosis, 11.5% presented Stage II, and 7.2% presented Stage I. There was no case of portal thrombosis. Splenomegaly was found in 83.2% of the cases and hepatomegaly in 48.9% of the cases. Porto-systemic shunt was detected in 80.7% of the cases and ascites in 72.3%. CONCLUSION: Ultrasonography examination represents an important role in the diagnosis of periportal fibrosis, in its staging process, and allows the assessment of porto-systemic, hepatic, and splenic alterations.
ABSTRACT
Medical profession is stressful and can cause professional exhaustion syndrome or Burnout syndrome (BOS). This study aims to determine Burnout syndrome levels (low, medium, high) by its dimensions and by causing factors related to physicians' professional activity. We conducted a cross-sectional study based on self-administered questionnaire to practicing physicians in Soavinandriana Hospital Center and Joseph Ravoahangy Andrianavalona University Hospital in 2012. Correlation and linear regression analyses were made (SigmaStat® 3.5). Out of 138 hospital physicians, questionnaire response rate was 47.1%. Forty eight medical records were selected. The study population was male-dominated (sex ratio: 1.8) with a median age of 37 [25-59] years. Physicians-in-training and assistant physicians accounted for 56.3% of the study population. According to the seniority of the physicians, 16.7% had worked for less than 1 year. Burnout syndrome was found in 51.2% of physicians, of whom 4.2% had high syndrome levels. Occupational status was significantly correlated with Burnout syndrome and with its level (p=0.0142 and p=0.0362), including emotional exhaustion (p=0.0414). BOS wasn't related with physician seniority and sector of activity. BOS in hospital environment is mainly related to occupational status. Early diagnosis is essential to prevent its deleterious effects.
Subject(s)
Burnout, Professional/epidemiology , Employment/psychology , Occupational Stress/epidemiology , Physicians/psychology , Adult , Cross-Sectional Studies , Female , Hospitals, University , Humans , Madagascar , Male , Middle Aged , Surveys and QuestionnairesABSTRACT
The management of esophageal atresia is still limited due to the precariousness of technical equipments in Madagascar. Our case study aims to highlight possible therapeutic options and to describe the progresses to be made so as to optimize treatment of this congenital pathology. We collected the medical records of all patients hospitalized for esophageal atresia in the Department of Surgical Reanimation at the University Hospital-JRA Antananarivo. The first patients admitted who survived for a period of 42 months (between January 2011 and June 2014) were included in the study. Among the 17 patients admitted with esophageal atresia, three full-term newborns with type III esophageal atresia, successively admitted in Surgical Reanimation, were the first patients in Madagascar to survive after surgery. Only one patient had associated malformations. These three babies were extubated early in the operating room; they underwent oxygen therapy until normal spontaneous breathing. New-born babies underwent post-operatory physical therapy allowing to improve their respiratory status. Overall mortality rate from this pathology was 76.5% in 42 months. Despite these initial success, progresses still remain to be done in the treatment of this congenital anomaly, from diagnosis up to postoperative period. The improvement of technical equipments, especially ventilation and nutritional support equipments would allow more meaningful results, like in the countries where progresses has been made in the field of reanimation.
