Evaluation des effets du dichlorate d'hydroxyzine sur l'anxiete preoperatoire et appreciation de l'information donnee aux malades

Evaluer l'anxiete preoperatoire des patients proposes pour une chirurgie elective et apprecier l'information recue du chirurgien et de l'anesthesiste.Type d'etude : Etude prospective et longitudinale sur deux enquetes de pratique hospitaliere. Patients et methode : Tous les patients ages de 16 ans et plus; de classe ASA I et II; admis en hospitalisation pour subir une intervention chirurgicale programmee durant la periode allant du 1er janvier au 30 avril 2007 et apres consentement eclaire; ont ete repartis en deux groupes de facon aleatoire. Les malades appartenant au groupe d'intervention ont recu chacun une premedication au dichlorate d'Hydroxyzine. L'anxiete preoperatoire a ete mesuree dans les deux groupes au moyen de l'echelle visuelle analogique (EVA). Resultats : Sur 145 patients initialement inclus; 139 ont pu participer a l'etude. Il n'y avait pas de difference statistiquement significative entre les deux groupes en ce qui concerne leurs scores d'anxiete avant ou apres la premedication. Par contre; nos resultats montrent que la plupart de nos patients n'avaient recu; en preoperatoire; que partiellement ou pas du tout d'informations sur les actes chirurgicaux et anesthesiques prevus.Conclusion : Les patients sont demandeurs d'informations et une bonne preparation psychologique pourrait reduire de facon sensible l'anxiete preoperatoire et prevenir certains incidents et/ou complications per ou postoperatoires

[The fight against rabies in Africa: from recognition to action]. / Lutte contre la rage en Afrique: du constat à l'action.

As a follow-up to the first AfroREB (Africa Rabies Expert Bureau) meeting, held in Grand-Bassam (Côte-d'Ivoire) in March 2008, African rabies experts of the Afro-REB network met a second time to complete the evaluation of the rabies situation in Africa and define specific action plans. About forty French speaking rabies specialists from Northern, Western and Central Africa and Madagascar met in Dakar (Senegal), from March 16th to 19th, 2009. With the participation of delegates from Tunisia, who joined the AfroREB network this year, 15 French speaking African countries were represented. Experts from the Institut Pasteur in Paris, the Alliance for Rabies Control, and the Southern and Eastern African Rabies Group (SEARG, a network of rabies experts from 19 English speaking Southern and Eastern African countries) were in attendance, to participate in the discussion and share their experiences. AfroREB members documented 146 known human rabies cases in all represented countries combined for 2008, for a total population of 209.3 million, or an incidence of 0.07 cases per 100,000 people. Even admitting that the experts do not have access to all reported cases, this is far from the WHO estimation of 2 rabies deaths per 100,000 people in urban areas and 3.6 per 100,000 in rural Africa. It was unanimously agreed that the priority is to break the vicious cycle of indifference and lack of information which is the main barrier to human rabies prevention.

[Early outcome of digestive surgery in a tropical setting]. / Evolution post-opératoire précoce en chirurgie digestive en milieu tropic.

OBJECTIVE: The purpose of this report was to describe early outcome of surgical management of digestive disease in a tropical setting. Study design. This retrospective, descriptive study was carried out in Benin over the three-year period from January 1, 2002 to December 31, 2004. PATIENTS AND METHODS: A total of 613 patients admitted to the intensive care unit (ICU) following surgical treatment for digestive disease were studied. Data were collected on cards from ICU patient admission records, duty register, and patient charts. The data obtained by exact transcription from cards was entered into the Epidata 3.02 software package and analyzed using the Stata 8.0 software package. RESULTS: Patients undergoing surgery for digestive disease accounted for 32% of admissions to the ICU during the study period. Mean patient age was 30 years (range, 1 day to 85 years). Surgery was carried out under emergency conditions in 510 patients and elective conditions in 103. The most common surgical indications were peritonitis, acute bowel occlusion, and malignant tumors. Overall postoperative morbidity was 25.8% with a strong male prevalence (27.6% after emergency procedures and 16.5% after elective procedures). Most complications (74.7%) occurred within 4 days after the procedure. Complications rare occurred after the 6th post-operative day. Overall mortality was 13% (13.3% after emergency procedures and 11.6% after elective surgery). The most frequent cause of death was sepsis. In the vast majority of the cases (78.7%) death occurred in the first 72 hours. CONCLUSION: Post-operative morbidity and mortality remain high in our ICU especially after surgical management of digestive disease. Although this finding is correlated with inadequate technical and human resources, it is mainly due to delayed treatment or slow evacuation time with most patients being admitted in extremely critical condition. Elective surgery was usually performed on patients presenting advanced-stage malignancy. Delayed management with subsequent deterioration of the patient's clinical state was frequently due to prior treatment by practitioners of traditional medicine.

Fighting rabies in Africa: the Africa Rabies Expert Bureau (AfroREB).

Rabies experts from 14 francophone African countries met in Grand Bassam (Côte d'Ivoire), 10-13 March 2008. They presented the situation in their respective countries, acknowledging the lack of rabies awareness among the population, health care workers and health authorities. They recognized that infrastructure for the management of rabies exposure is scarce, modern vaccines are in limited quantity and immunoglobulins are lacking in most of their countries. They defined as a priority the need to have reliable figures on the disease burden, which is necessary for informed decision making and priority setting, and for applying for aid in controlling the disease. This meeting sealed the establishment of the Africa Rabies Expert Bureau (AfroREB).

[Toxic epidermal necrolysis. Epidemiologic, clinic and therapeutic aspects at Cotonou University and National Teaching Hospital]. / Nécrolyse épidermique toxique. Revue des cas observés dans le service de réanimation du centre national hospitalier et universitaire de Cotonou.

INTRODUCTION: Toxic epidermal necrolysis (TEN) is usually a drug-induced disease, involving vital or functional prognosis with 20 to 30% mortality rates. OBJECTIVES: The aim was to collect cases of TEN in an intensive care unit in Cotonou National University and Teaching Hospital, and describe epidemiologic, clinical, therapeutic and evolutive patterns. STUDY DESIGN: Retrospective and descriptive study over five years. PATIENTS AND METHODS: The medical report-forms of patients admitted between January 1998 and December 2002, for toxic dermatitis with total skin injury area more than 10% were reviewed. RESULTS: Fourteen patients with TEN were identified. The average incidence was three cases per year, accounting for 0.25% of the admissions in the unit. Sulphonamides (n=4), antituberculous drugs (n=2), penicillin (n=3) were the main cause of TEN. In five patients, the cause was not found. Self-medication was found in 7 patients. Total skin injury area reached from 26 to 87%. Mucosal and viscera injury occurred in respectively 11 and 9 patients. The treatment was usual as in extended burns. Four patients died (28.5%). The average time before hospitalisation was 11.4 days. CONCLUSION: The growing-awareness of people can prevent/reduce the morbidity and improve the prognosis of TEN.

[Intensive care management of patients with severe head traumatism in Benin from 1998 to 2002]. / Traumatismes crâniens graves en réanimation au Bénin de 1998 à 2002.

OBJECTIVE: To study in Cotonou (Benin) in tropical environment, the specific problems of severe head injury. STUDY DESIGN: Five years retrospective study in Cotonou University National and Teaching Hospital. PATIENTS AND METHODS: All patients admitted with severe head injury between January 1998 and December 2002 were included. The following parameters were studied: age, sex, traumatism cause, temperature, blood pressure, Glasgow coma scale. RESULTS: Two Hundred thirty six patients (mean age 32 +/- 18 years) essentially men, were admitted. The cause of the injury was road traffic accidents in 86% of cases. Prehospital medicalisation was achieved in only 9% of cases. A head CT-scan was performed in 5% of the cases. Respiratory resuscitation essentially used the association intubation and oxygenation (59%), 19% of the patients were ventilated and 21% were sedated. Mortality was closely related to the initial Glasgow coma scale score (GCS): GCS 3-4 = 97%; GCS 5-6 = 72% GCS 7-8 = 36%. Overall mortality was 70%. CONCLUSION: Severe head injury is a major cause of morbidity and mortality in developing countries. Limited access to highly specialised care explain a high mortality rate. An active policy of prevention from administrative authorities and a greater effectiveness of medical management may improve outcome.

[Case report of acute intoxication from intravenous injection of petroleum] . / A propos d'un cas d'intoxication aiguë par injection intraveineuse directe de pétrole.

A 18-year-old patient injected intravenously 2.5 mL of paraffin oil into the right upper limb. It caused a local thrombophlebitis with a slow evolution. A collapsus occurred on the sixth day. The authors obtained a clinical recovery of the limb after heparine and oral anticoagulation.

[A case of acute pyrimethamine poisoning]. / A propos d'un cas d'intoxication aiguë à la pyriméthamine.

Intoxication by pyrimethamine is rare compare to these of patients who ingest a massive dose of amino-4-quinoleine. Clinic manifestations can be delayed and they are specially based on haematologic disorder as shown by literature data. Others organs can be concerned. The authors would like to present the case of a patient with a severe pancytopenia accompanied with: ocular blow like hyperhaemia of conjunctiva then iris siderosis. skin attack as Gunther's disease. Etiologic treatment by folinic acid is the only deduction. Recovery is complete.

[Caudal and spinal anesthesia in sub-umbilical surgery in children. Apropos of 1875 cases]. / Anesthésie caudale et rachianesthésie dans la chirurgie sous-ombilicale chez l'enfant. A propos de 1875 cas.

Caudal and spinal anaesthesia are two techniques widely used in European children. The aim of this retrospective study was to evaluate the applicability of this practice in developing countries. The study concerned 1875 children, 1 day to 17 years old. isobaric 0.5% bupivacaine was used for spinal anaesthesia (n = 730) and mixture a of 1% lidocaine-0.25% bupivacaine with epinephrine 1/200,000 for caudal anaesthesia (n = 1,145). Spinal anaesthesia was performed in neonates and infants (< 3 years) and caudal anaesthesia in children (aged 14 days to 17 years) undergoing urological and lower extremity surgery. No variation of heart rate, blood pressure or blood oxygen saturation (SpO2) were observed during surgery. Failure of the technique was less than 1%. These two regional anaesthesia techniques are easy to perform and are inexpensive. This is advantageous for developing countries.

Prise en charge des malformations chirurgicales digestives de l'enfant dans le service polyvalent d'anesthési-réanimation

Les malformations digestives de l'enfant sont souvent des urgences chirugicales a la naissance avec une gravite preoccupante dans les suites operatoires. Dans le but d'evaluer la frequence et le pronostic de ces malformations; les auteurs analysent les observations de 38 enfants recus en 5 ans dans le service polyvalent d'anesthesie reanimation du Centre National Hospitalier et Universitaire de Cotonou. Les malformations congenitales sont essentiellement des imperforations anales; des atresies et stenoses digestives; des omphaloceles et des maladies de Hirshprung. Elles representent 1;8 pour cent des admissions du service et 5 pour cent des urgences chirurgicales digestives. Excepte; tous les enfants sont operes le jour de leur admission. Les suites operatoires ent ete marquees par: 22 cas de deces soit 57;9 pour cent et 7 cas de complications a type de peritonites; fistules et occlusions. Le pronostic est lie a la specificite du terrain du nouveau-ne et au retard de diagnostic