Les accidents domestiques chez l'enfant de 0 à 15 ans : Une étude prospective multicentrique sur 1064 cas Burundais

Les accidents domestiques constituent une cause fréquente de traumatisme chez l'enfant. Ils sont multifactoriels et leur type varie selon le développement psychomoteur et cognitif de l'enfant et de l'environnement familial. Cette étude visait à déterminer le profil de l'enfant victime d'accident domestique et les caractéristiques de type d'accident. Il s'agissait d'une étude multicentrique, descriptive prospective réalisée dans les 4 hôpitaux de niveau tertiaire de Bujumbura au Burundi. L'étude incluait tous les enfants âgés de 0 à 15 ans, victimes d'un accident domestique, qui ont été reçus dans un de ces 4 centres sur une période d'un an allant du 23juin 2016 au 23 juin 2017. Les accidents domestiques représentaient 61% de tous les cas d'accidents (n=1064) reçus aux services d'urgences des hôpitaux concernés au cours de cette période. La majorité étaient des garçons (sex ratio = 1,55). Les enfants de moins de 5ans représentaient 61% des cas (n=653) et parmi eux ceux âgés de 2 à 5ans représentaient 67% (n=439). Au moment de l'accident, la supervision des enfants était assurée par la mère ou une autre personne ayant la garde de l'enfant dans 34% des cas (n=394). Ces accidents survenaient pendant le jeu dans 79% des cas et à l'intérieur de la maison dans 51% des cas. Les traumatismes par chutes (61% des cas) et les brulures (26% des cas) constituaient les deux premières causes de ces accidents. Les autres causes d'accidents domestiques sont l'ingestion, l'inhalation ou l'introduction dans les orifices naturels de corps étrangers (11% des cas), l'intoxication (1%) et l'électrocution (0,1%). Les suites étaient simples dans 92% des cas (n=974) avec une guérison complète. L'accident domestique avait entraîné le décès de la victime dans 0,4% des cas (n=4) et des séquelles fonctionnelle et esthétiques dans 8% des cas (n=86). Les accidents domestiques de l'enfant sont la cause la plus fréquente de traumatismes avec des conséquences vitales ou fonctionnelles. Des programmes de prévention devraient orienter leurs actions vers une meilleure information des personnes ayant en charge la supervision des enfants et même des enfants plus âgés ainsi que l'aménagement des lieux pour réduire les sources de danger

[Circulating vaccine-derived poliovirus type 2 outbreak in Democratic Republic of Congo 2011-2012]. / Épidémie de poliovirus circulants dérivés de souches vaccinales de type 2 en République démocratique du Congo de 2011 à 2012.

According to the WHO records of 2013, the incidence of poliomyelitis was reduced by more than 99%, the number of endemic countries decreased from 125 in 1988 to 3 in 2013 and over 10 million cases were prevented from poliomyelitis thanks to the intensive use of Oral polio vaccine (OPV). However, the emergence of circulating vaccine-derived poliovirus strains (cVDPV), causing serious epidemics like the wild poliovirus, is a major challenge on the final straight towards the goal of eradication and OPV cessation. This paper describes the cVDPVoutbreak that occurred in the Democratic Republic of Congo (DRC) from November 2011 to April 2012. All children under 15 years of age with acute flaccid paralysis (AFP) and confirmed presence of cVDPV in the stool samples were included. Thirty (30) children, all from the administrative territories of Bukama and Malemba Nkulu in the Katanga Province (south-east DRC), were reported. The virus responsible was the cVDPV type 2 (0.7% -3.5% divergent from the reference Sabin 2 strain) in 29 children (97%) and the ambiguous vaccine-derived poliovirus strain (0.7% divergent) was confirmed in one case (3%), a boy seventeen months old and already vaccinated four times with OPV. Twentyfive children (83%) were protected by any of the routine EPI vaccines and 3 children (10%) had never received any dose of OPV. In reaction, DRC has conducted five local campaigns over a period of 10 months (from January to October 2012) and the epidemic was stopped after the second round performed in March 2012. As elsewhere in similar conditions, low immunization coverage, poor sanitation conditions and the stop of the use of OPV2 have favoured the emergence of the third cVDPV epidemic in DRC. The implementation of the Strategic Plan for Polio eradication and endgame strategic plan 2013-2018 will prevent the emergence of cVDPV and set up the conditions for a coordinated OPV phase out.

Les modifications des hormones thyroidiennes après thyroidectomie partielle à propos d'une serie de 49 patients opérés à l'hôpital national de Niamey

C'est une etude prospective realisee dans le service de chirurgie de l'Hopital National de Niamey sur 49 patients porteurs de goitre cliniquement euthyroidien ayant beneficie d'une thyroidectomie partielle. Elle a eu comme but d'analyser les modifications biologiques a J5 et J30 apres une thyroidectomie partielle. Les modifications recherchees concernaient la T3; la TSH; la calcemie; la phosphoremie et la cholesterolemie. Dans la serie; il y a une predominance feminine avec 47 femmes pour 2 hommes. Le goitre multinodulaire predomine dans 43des cas. Les techniques operatoires utilisees ont ete la thyroidectomie dans 84des cas. Les suites operatoires ont ete simples chez 88de nos patients. Les complications sont survenues dans 12des cas et la plus frequente a ete l'hematome compressif dans 6;12des cas et l'atteinte recurrentielle dans 4;08des cas. Une variation significative du taux de T3 a type de diminution a ete retrouvee en postoperatoire. La frequence des sujets en hypocalcemie passe de 7 a 37a J30 avec un pic a 47a J5. L'analyse des variations du phosphore et du cholesterol sanguin montre des variations d'interpretation difficile a cause du nombre peu eleve dans le dosage de reference. Les resultats de l'etude amenent a recommander le dosage systematique des hormones thyroidiennes avant l'intervention; un dosage de la TSH a J5 et un dosage de la calcemie a J30

[Colonic pseudo-obstruction disclosing bladder calculi: report of 2 cases]. / Pseudo-obstruction colique, révélatrice d'un empierrement vésical: à propos de 2 cas.

The authors report two cases of acute intestinal obstruction caused by bladder calculi and insist on differential clinical diagnosis. Simple X ray and sonography seemed to be sufficient-for diagnosis of this extrinseque colique obstruction and management consisted of removal of the bladder stones The prognosis is excellent.

[Prognosis of strangulated inguinal hernia in the adult: influence of intestinal necrosis. Apropos of 34 cases]. / Pronostic de la hernie inguinale étranglée de l'adulte: influence de la nécrose intestinale. A propos de 34 cas.

The aim of this study was to determine the outcome for patients treated for strangulated inguinal hernia with intestinal resection for gangrenous. Between May 1997 and November 1998, 124 patients were admitted to our hospital for acute intestinal obstruction; 34 of them were treated for strangulated inguinal hernia and 17 underwent an intestinal resection. The outcome for the 34 patients with strangulated hernias were analysed retrospectively. Strangulated inguinal hernia occurred in young patients (80 per cent of our patients were aged under 45 years) and strangulation had evolved over an average of 2.5 days. The clinical picture was simple strangulated hernia in 10 cases, with intestinal obstruction syndrome in 15 cases, peritonitis in 3 cases, phlegmonous hernia in 4 cases, and fistulae in one case. Fifty per cent of patients had intestinal resection with poor means of resuscitation. This resection concerned 80 per cent of patients with strangulation lasting over 72 hours. Surgical repair of hernia was performed in 24 cases at the same time. There were numerous complications, notably: wound sepsis (16 cases), post-operative peritonitis (3 cases) and multiple system failure (12 cases). The mortality rate was 40 per cent and concerned 86 per cent of patients with small bowel necrosis and 89 per cent of those admitted after 96 hours of strangulation.

Diffuse papillomatosis of the gallbladder: case report of a hydropic gallbladder.

We present the case of a 47 year-old man with a gallbladder papillomatosis. His medical history showed typical biliary symptoms with chronic colicky pain and two episodes of jaundice. Unusually, the patient himself discovered a right hypochondrial mass which appeared to be a hydropic gallbladder. Pre-operative diagnosis was done by ultrasonography and percutaneous cholecystography. A cholecystectomy was performed. Gross description and microscopic examination confirmed the diagnosis of benign diffuse papillomatosis involving the entire mucosal surface of the gallbladder. The clinical and anatomical aspects of this lesion are discussed.

[Clinical and bacteriological outcome of wounds treated with honey. An analysis of a series of 40 cases]. / Evolution clinique et bactériologique des plaies traitées par le miel. Analyse d'une série de 40 cas.

Since a long time, honey has been used in wounds and skin ulcer treatment. Nowadays, it's healing properties are again being discovered. Its good application on wounds and infected burns gives satisfactory results. This work is a study done on 40 patients with wounds of various origin. Honey has healed 88 per cent of the cases. Some germs have been found on the wound at the end of the cicatrization but have not blocked the healing process. This simple, efficient, cheap and with no side effects treatment deserves being better known and integrated in the set of common antiseptics.

[Treatment of wounds with honey. 40 cases]. / Traitement des plaies par le miel. 40 observations.

Honey has been used long ago to treat wounds and cutaneous ulcers, and its healing properties have recently been rediscovered. Its applications on wounds or infected burns give satisfactory results. In a study of 40 patients with wounds of various origin honey provided healing in 88 percent of the cases. At the end of the healing process a few microorganisms were isolated from the wounds, but they did not prevent consolidation. This treatment, therefore, seems to be effective; moreover, as it is simple and inexpensive it should be better known and added to the list of commonly used antiseptic products.

[Evaluation of the surgical treatment of duodenal ulcers. Apropos of 616 patients operated on in Bujumbura]. / Bilan du traitement chirurgical de l'ulcère duodénal. A propos de 616 patients opérés à Bujumbura.

From 1982 to 1989, 616 patients were operated for duodenal ulcers in Bujumbura. 497 were men and 119 females. The mean age was 38.4. The indication for surgery was the failure of medical treatment for 56.8%. Other complications presented 41.4% and 1.8% of the patients had recurring ulcer after previous operation. The study was divided into two periods: Period I (1982-1985) and period II (1986-1989). During Period I, we observed a rapid drop of frequency in interventions and the indication for complication constituted 58% of the total surgical interventions. In period II, the frequency of interventions increased and the indication for complications did not exceed 35.6%. Ulcerous stenosis remained the most frequent complication. The choice of surgical intervention is changing into favour of techniques like highly selective vagotomy.

[Histopathological findings: (apropos of 395 thyroidectomies in Burundi)]. / Données histopathologiques: (à propos de 395 thyroïdectomies au Burundi).

Analysis of 395 thyroidectomies, in a tropical region of endemic goiter and in a Hospital Department without any mean of investigation of thyroid gland, led to the establishment of the following facts: Prevalence of female sex is clear (72.1 p.c.). Thyrotoxicosis appears to be infrequent (1.5 p.c.). Cancer of thyroid strikes 7.8 p.c. of the operated patients. Operative morbidity is 3 p.c. Lesions of the recurrent laryngeal nerve have been observed in 3.8 p.c. of the patients. Then these results are examined in light of the date of known publications.