Snakebite in Bobo-Dioulasso, Burkina Faso: illustration of realities and challenges for care based on a clinical case

We report herein the case of 19-year-old female farmer who suffered a double snakebite on the right foot. After an unsuccessful traditional treatment, she consulted a health center, 48 hours after the bite. Upon arrival at the hospital, she showed signs of severe damage, including hemorrhagic syndrome, extensive gangrene of the bitten limb and severe acute renal failure. Due to financial constraints, neither antivenom nor the scheduled amputation was performed. After 35 days of hospitalization, she returned home, against the advice of medical personnel. Our case summarizes the daily challenges of patients and practitioners that suffer snakebite envenomation in Bobo-Dioulasso, western Burkina Faso.(AU)

[Transfer of obstetric patients in a pregnant and postpartum condition to an intensive care unit: eighty-two cases in Burkina Faso]. / Transfert de patientes en état gravido-puerpéral en réanimation: à propos de 82 cas au Burkina Faso.

OBJECTIVE: To review all obstetric admissions to an intensive care unit (ICU) of an African hospital. PATIENTS AND METHODS: Retrospective analysis of the records of all obstetric patients admitted to the ICU of Souro Sanou Hospital in Burkina Faso, from January 1st, 1996, to June 30, 1998. RESULTS: Eighty-two patients out of 6119 deliveries were transferred to the ICU, which meant a 1.34% transfer rate. These transfers concerned young patients (mean age of 24 years), coming originally from outlying maternities in 52.4% and having already given birth in 64.63% of the cases. The two main diagnoses at the ICU were: eclampsia and septic shock. The large majority of the patients (73 out of 82) had at least one bad prognosis factor at admission at the ICU. A maternal mortality rate of 60% was noted, the main risk factors for mortality being acute respiratory condition and severe anemia. CONCLUSION: Mortality of obstetric patients admitted to ICUs is very high in our setting. Establishing an ICU within the obstetric unit or early detection of cases to be transferred (scoring system?) should improve the prognosis.

[Value of intrathecal baclofen in the treatment of severe tetanus in the tropical milieu]. / Place du baclofene intrathecal dans le traitement du tetanos grave en milieu tropical.

Tetanus continues to be a cause of high mortality in developing countries, where resources for muscle relaxation and respiratory support are not readily available. Baclofen, a GABAB receptor agonist, directly restores physiologic inhibition of alpha motoneuron, that is blocked by tetanus toxin. Its use has been suggested at high dosage by intrathecal (i.t.) route, as part of the treatment of tetanus-induced contractures, and to limit the need for general anesthesia and for tracheal intubation in afflicted patients. This review reports personal experience and focuses on published data about i.t. baclofen for severe tetanus. Although statistical analysis are difficult to perform, i.t. baclofen appears to be effective in resolving muscle rigidity and in avoiding the need for deep sedation and for tracheal intubation, thus achieving lower mortality. Nevertheless, i.t. baclofen has a narrow therapeutic range, and a large interindividual pharmacodynamic variability. Thus, its use should be reserved for patients who would have been intubated without it. I.t. baclofen is a fairly simple and cost-effective modality, with significant advantages for management of severe tetanus, especially in tropical environment.

A preliminary germplasm evaluation of onion landraces from West Africa.

Genetic erosion is observed in traditional populations of onion in West Africa. The present study aimed to assess the agronomical potential for six important traits of 14 landraces collected in West Africa. A multivariate procedure was used to establish a classification within this germplasm on the basis of these traits. The phenotypic variability both within and between landraces is considerable but could be due to traditional agricultural practices still occurring in this area. Three statistically coherent clusters have been identified despite the great phenotypic variation between landraces and could be a basis for building a core collection of West African onion germplasm. This first analysis of traditional onion landraces provides convincing information regarding their agronomic potential. Key words : Allium cepa L., onion, genetic resources, diversity.

[Sore throat after tracheal intubation]. / Douleurs laryngées après intubation trachéale.

This study was performed to determine the incidence of sore throat 24 h after tracheal intubation in 1,268 patients ASA I or II, who had undergone elective surgery. A data form was completed. Nosing were age, sex, type of surgery, anaesthetic drug, muscle relaxant, number of intubation attempts, duration of intubation, and presence of sore throat. The incidence of sore throat was 15.06%. It was significantly higher in females than in males (19.29% vs 11.66%; P < 0.01). There was a significant difference between those patients who received fentanyl and those who received pethidine (P < 0.05). There was also a greater incidence after thyroid surgery (P < 0.01). There was no correlation between sore throat and variables such as age, muscle relaxant, narcotic drug, number of intubation attempts, or duration of intubation. Lidocaine jelly and the appropriate analgesic drug reduce the incidence of sore throat following tracheal intubation.