Acute kidney failure following severe viper envenomation: clinical, biological and ultrasonographic aspects.

BACKGROUND: Acute kidney injury (AKI) is a frequent complication of snakebite envenomation, which is still little known in sub-Saharan Africa. This study aims to describe the clinical, biological and ultrasonographic aspects of AKI following severe snakebite envenomation managed in the intensive care unit. METHOD: A prospective observational survey was performed in Benin over a period of 18 months. All patients suffering severe snakebite envenomation (SBE) were included. The diagnosis of AKI was made using the KDIGO criteria. Kidney ultrasound exam was performed in all patients to assess internal bleeding and morphological and structural abnormalities of the kidneys. RESULTS: Fifty-one cases of severe SBE were included. All patients presented inflammatory syndrome and showed abnormal WBCT whereas bleeding was found in 46 of them (90%). The median time to hospital presentation was three days. The majority of patients were male (M/F sex ratio = 1.55) and the median age was 26. Sixteen patients (31%) showed AKI according to the KDIGO criteria. Severe AKI (KDIGO stage 2 and 3) was observed in three patients, including one stage 2 and two stage 3. Kidney ultrasound revealed three cases of kidney capsular hematoma (6%), two cases of kidney hypertrophy (3%), three cases of kidney injury (4%), two stage 1 KDIGO and one stage 2 KDIGO. Only one patient benefited from hemodialysis. All patients showing AKI recovered without sequels. The median duration of hospital stays was four days. Seven patients died (14%) including four among the 16 AKI patients. Antivenom has been administered to 41 patients (80%). The comparison between patients without and with AKI did not show any significant difference except gender (p = 10-2). CONCLUSION: AKI is a common complication of severe snakebite envenomation. Resulting from inflammatory and hemorrhagic disorders, AKI may prove to be a short-term life-threatening factor.

Acute kidney failure following severe viper envenomation: clinical, biological and ultrasonographic aspects

Acute kidney injury (AKI) is a frequent complication of snakebite envenomation, which is still little known in sub-Saharan Africa. This study aims to describe the clinical, biological and ultrasonographic aspects of AKI following severe snakebite envenomation managed in the intensive care unit. Method: A prospective observational survey was performed in Benin over a period of 18 months. All patients suffering severe snakebite envenomation (SBE) were included. The diagnosis of AKI was made using the KDIGO criteria. Kidney ultrasound exam was performed in all patients to assess internal bleeding and morphological and structural abnormalities of the kidneys. Results: Fifty-one cases of severe SBE were included. All patients presented inflammatory syndrome and showed abnormal WBCT whereas bleeding was found in 46 of them (90%). The median time to hospital presentation was three days. The majority of patients were male (M/F sex ratio = 1.55) and the median age was 26. Sixteen patients (31%) showed AKI according to the KDIGO criteria. Severe AKI (KDIGO stage 2 and 3) was observed in three patients, including one stage 2 and two stage 3. Kidney ultrasound revealed three cases of kidney capsular hematoma (6%), two cases of kidney hypertrophy (3%), three cases of kidney injury (4%), two stage 1 KDIGO and one stage 2 KDIGO. Only one patient benefited from hemodialysis. All patients showing AKI recovered without sequels. The median duration of hospital stays was four days. Seven patients died (14%) including four among the 16 AKI patients. Antivenom has been administered to 41 patients (80%). The comparison between patients without and with AKI did not show any significant difference except gender (p = 10-2). Conclusion: AKI is a common complication of severe snakebite envenomation. Resulting from inflammatory and hemorrhagic disorders, AKI may prove to be a short-term life-threatening factor.(AU)

[Impact of HIV status on the overall prevalence of chronic hepatitis B infection in Parakou, Benin]. / Prévalence de l'hépatite B chronique selon le statut sérologique VIH à Parakou au Bénin.

INTRODUCTION: The prevalence of hepatitis B is very variable across geographic areas and seems to be influenced by HIV infection. This study aims to evaluate the impact of serologic HIV status on the overall prevalence of hepatitis B in a Hospital in Parakou, Benin. METHODS: We conducted a cross-sectional study of adults aged 18 years old and over hospitalized in the Departmental University Hospital Center in Parakou between May 2011 and June 2012. The diagnosis of hepatitis B was made on the basis of rapid HBsAg tests while the diagnosis of HIV was made on the basis of rapid HIV tests using venous blood samples. Data were analyzed using EpiInfo software. Multivariate logistic regression model was implemented to investigate factors associated with hepatitis B. RESULTS: Out of 1516 subjects included, 744 were HIV seropositive. The average age was 31.3 + 11.1 years and 65.1% were women. The prevalence rate of hepatitis B in the whole sample was 13.9% [CI95:12.2%-15.7%]. This prevalence was higher in HIV seropositive subjects (16.9% vs 10.9%; p < 0.0006), however there was not a more significant difference in multivariate analysis, except for the group of subjects from Borgou/Alibori (p < 0.02). A consistent association was observed between age group 24-44 years (p < 0.03), male sex (p < 0.01), primary school education (p < 0.02) and a high prevalence of hepatitis B. CONCLUSION: The prevalence of hepatitis B was higher in HIV seropositive subjects. This was influenced by age, sex, education level and geographical origin.

Contribution of ultrasonography to the diagnosis of internal bleeding in snakebite envenomation.

BACKGROUND: In Africa, snakebite envenomations are frequently complicated by life-threatening hemorrhagic syndromes. The authors of the present study conducted a prospective analysis at the University Hospital of Parakou (north of Benin) for seven months (January 1 to July 31, 2014) to assess the contribution of ultrasonography to the diagnosis of internal bleedings and management of envenomation. METHODS: An ultrasound examination was performed in all patients with clinical envenomation regardless of its severity. The study involved 32 patients admitted to the ICU of the University Hospital of Parakou. RESULTS: The average age was 27 ± 13.9 years. The main signs of severity were: prolongation of clotting time (88 %), severe anemia (41 %), clinical hemorrhage (47 %), and shock (19 %). The ultrasound imaging showed internal hemorrhage in 18 patients (56 %). There were hematomas (22 %), hemoperitoneum (13 %) or a combination of both (22 %). The occurrence of internal bleeding and hemoperitoneum were mainly related to the delay of hospital presentation (p = 0.007) and the existence of external bleeding (p = 0.04). Thirty patients (94 %) received antivenom. Case fatality rate was 3.1 %. CONCLUSION: Ultrasonography may help in diagnosing internal bleeding, even in patients that did not show external hemorrhages, and evaluating its importance. As a consequence, the management of snakebite victims may be significantly improved.

Contribution of ultrasonography to the diagnosis of internal bleeding in snakebite envenomation

Background In Africa, snakebite envenomations are frequently complicated by life-threatening hemorrhagic syndromes. The authors of the present study conducted a prospective analysis at the University Hospital of Parakou (north of Benin) for seven months (January 1 to July 31, 2014) to assess the contribution of ultrasonography to the diagnosis of internal bleedings and management of envenomation. Methods An ultrasound examination was performed in all patients with clinical envenomation regardless of its severity. The study involved 32 patients admitted to the ICU of the University Hospital of Parakou. Results The average age was 27 ± 13.9 years. The main signs of severity were: prolongation of clotting time (88 %), severe anemia (41 %), clinical hemorrhage (47 %), and shock (19 %). The ultrasound imaging showed internal hemorrhage in 18 patients (56 %). There were hematomas (22 %), hemoperitoneum (13 %) or a combination of both (22 %). The occurrence of internal bleeding and hemoperitoneum were mainly related to the delay of hospital presentation (p = 0.007) and the existence of external bleeding (p = 0.04). Thirty patients (94 %) received antivenom. Case fatality rate was 3.1 %. Conclusion Ultrasonography may help in diagnosing internal bleeding, even in patients that did not show external hemorrhages, and evaluating its importance. As a consequence, the management of snakebite victims may be significantly improved.(AU)

Contribution of ultrasonography to the diagnosis of internal bleeding in snakebite envenomation

In Africa, snakebite envenomations are frequently complicated by life-threatening hemorrhagic syndromes. The authors of the present study conducted a prospective analysis at the University Hospital of Parakou (north of Benin) for seven months (January 1 to July 31, 2014) to assess the contribution of ultrasonography to the diagnosis of internal bleedings and management of envenomation. Methods An ultrasound examination was performed in all patients with clinical envenomation regardless of its severity. The study involved 32 patients admitted to the ICU of the University Hospital of Parakou. Results The average age was 27 ± 13.9 years. The main signs of severity were: prolongation of clotting time (88 %), severe anemia (41 %), clinical hemorrhage (47 %), and shock (19 %). The ultrasound imaging showed internal hemorrhage in 18 patients (56 %). There were hematomas (22 %), hemoperitoneum (13 %) or a combination of both (22 %). The occurrence of internal bleeding and hemoperitoneum were mainly related to the delay of hospital presentation (p = 0.007) and the existence of external bleeding (p = 0.04). Thirty patients (94 %) received antivenom. Case fatality rate was 3.1 %. Conclusion Ultrasonography may help in diagnosing internal bleeding, even in patients that did not show external hemorrhages, and evaluating its importance. As a consequence, the management of snakebite victims may be significantly improved.

Surgical management of head trauma: problems, results, and perspectives at the departmental teaching hospital of Borgou, Benin.

OBJECTIVE: The purpose of this study was to report our neurosurgical experience with traumatic brain injury (TBI) at a departmental teaching hospital in Benin. METHODS: This was a descriptive study performed from January 2008 to June 2010. It concerned patients who received surgical treatment after a brain trauma. Conditions for surgical care were based on imaging data or exclusively on clinical symptoms (disorders of consciousness associated with focal signs). RESULTS: Sixty-two patients underwent surgical management during the study period. They accounted for 5% of the TBI cases hospitalized. There were 56 (90.3%) men and 6 (9.7%) women. The average age of patients was 26.38 ± 14.76 years. The main cause of injury was road traffic accident (80.6%). The mean time of admission to the surgical room was 27.59 ± 20.71 hours. The indication for surgery was based on clinical data in 17 (27.4%) patients, clinical and x-ray data in 27 (43.6%) patients, and computed tomography scan data in 18 (29%) patients. A burr-hole exploration was performed in 17 (27.4%) patients. Repair of depressive fracture or cerebral wound and evacuation of hematoma were mainly performed (75.8%). Complete recovery was observed in 34 (54.9%) patients. Sequels were observed in 10 (16.1%) patients. The postoperative mortality was 29% (n = 18). This mortality was 76.5% among 17 patients for whom burr-hole exploration was performed (P = 0.00000). CONCLUSION: Surgical treatment of TBI is a common activity in our practice, despite the difficulties. Good imaging and enhanced prevention could improve care and reduce TBI severity.