Tele-ECG improves diagnosis of acute coronary syndrome and ST-elevation myocardial infarction in Côte d'Ivoire.

Introduction: The emergence of cardiovascular risk factors in sub-Saharan Africa suggests an increasing incidence of acute coronary syndromes and STEMI. The aim of the study was to define the prevalence of STEMI and to describe the characteristics of patients diagnosed with STEMI within the tele-electrocardiogram (ECG) network in Côte d'Ivoire. Method: A retrospective study was conducted from January 2015 to August 2019. All adult patients managed by one of the six hospitals within the telemedicine network who benefited from a remote interpretation of their ECG by the cardiology department of Bouaké University Hospital were included. The main reason for ECG interpretation, patient and ECG characteristics, diagnosis, response time and treatment were described. Results: A total of 5649 patients were included. The prevalence of STEMI was 0.7% (n = 44 cases) with a mean age of 58.6 ± 11.8 years and a M/F sex ratio of 1.93. Among STEMI patients, chest pain was the main reason for ECG testing (56.8%). Most ECGs were interpreted within 12 hours (72.8%). The anterior inter-ventricular artery location (59.1%, n = 26) was predominant. The Q wave of necrosis was absent in 18% (n = 8) of cases. All patients received double anti-platelet aggregation and 50% (n = 22) additional heparin therapy. No patient underwent primary angioplasty or thrombolysis, 65.9% (n = 29) were referred to the Bouaké Cardiology Department and 34.1% (n = 15) to the Abidjan Heart Institute. Scheduled angioplasty was performed in 20% (n = 3) of patients in Abidjan. Conclusion: Tele-ECG was an effective means of STEMI screening in Côte d'Ivoire. Systematic telethrombolysis of all patients diagnosed could improve their prognosis.

[Prognosis of post-operative digestive fistulas in Chu de Yopougon: Abidjan/Cote d'Ivoire]. / Pronostic des fistules digestives post-operatoires au Chu de Yopougon : Abidjan/Cote d'Ivoire.

OBJECTIVE: Because of the difficulties to manage the post-operative digestive fistulas (FDPO) and their disappointing results, the authors led this survey. It's objective is to identify the prognosis factors in order to optimize their management and improve their prognosis. PATIENTS AND METHOD: It is a retrospective survey during 12 years, from January 1992 to December 2004 in the general and digestive surgery adult service of CHU Yopougon. It included 86 files of patients aged of 15 years at least presenting a FDPO. RESULTS: The middle age was of 36.8 years. The death rate was 29.06%. It rose with age. The risk of death was multiplied by 5.54 over age of 55 years (OR = 5.54 and p = 0.012). The number of death rose meaningfully with the length of the diagnostic delay (p = 0.016 for OR1 = 1.64 and OR2 = 8.94. The death rate was raised more in the exposed fistulas that in the controlled fistulas (87% against 45%). In 50% of the cases the death occurred when the debit was superior or equal to 500 cc daily. Among the patients submitted to the medical treatment 69.70% had a spontaneous closing of their fistula in a middle delay of 27.18 days for extremes varying between 13 and 47 days. CONCLUSION: The affection is very serious considering it's death rate. A precocious diagnosis and a fast and adapted management should permit to reduce this higher mortality.

[Splenectomy for splenomegaly in Ivory Coast. Indications and short term results]. / Splenectomies pour splenomegalie en Cote d'Ivoire. Indications et résultats précoces.

AIM: To study the indications and evaluate the short term results of splenectomy for splenomegaly. PATIENTS AND METHODS: This retrospective analysis concerned 31 males and 21 feméles with a mean age of 30,5 yersin old, from February 1998 to December 2003. The aetiologies of splenomegaly were parasites (n=6), benign haematological diseases (n= 24), haematological malignancies (n=6), infections (n=3) and cysts (n=3). The indications were due to hypersplenism in 39 cases (79,5%), risk of splenic rupture in 46 cases (88,5%), infection or risk of infection in 3 cases and painful splenomegaly in 3 cases. 49 nine patients underwent complete splenectomy and the 3 remaining had a partial splenectomy. A spleno-renal shunt in three cases, mesenterico-adrenal shunt and mesenterico-cave shunt were associated for portal hypertension. A lengthy penicillinotherapy in all the patients and thromboembolic prevention in some were performed. RESULTS: The mean hospital stay was 6.3 days. Correction of cytopenia and permanent pain relief occurred in all cases. One patient died from intraoperative haemorrhage and 2 other from unknown cause postoperatively (09%). Morbidity was due to hyperthermy in 3 cases, abdominal haemorrhage by splenic vessel ligation leakage and bridles obstruction in one case. CONCLUSION: This study shows that hypersplenism constituted the mean indication of splenectomy. Its low mortality and morbidity suggest that it might be usually used in our practice. These results may be improve by laparoscopic splenectomy and systematic prevention of postoperative complications.

Plastrons appendiculaires en Cote d'Ivoire : aspects epidemiologiques et therapeutiques

Les auteurs rapportent leur experience sur les plastrons appendiculaires a propos de 100 cas. 20 malades ont ete traites en urgence d'un plastron appendiculaire abcede. 80 sont rentres dans le protocole medico-chirurgical qui a consiste a traiter medicalement la masse qui a regresse en 10 semaines en moyenne suivi d'une intervention. La mortalite post-operatoire etait nulle et la morbidite de 15;6 pour cent representee par des supurations parietales minimes

L'antibioprophylaxie dans un service de chirurgie générale en milieu africain: étude préliminaire de 120 cas au CHU de Treichville

Les auteurs rapportent leur experience a propos de l'antibioprophylaxie en milieu chirurgical; devant les problemes poses et le cout de l'antibiotherapie l'ATB systematique de couverture. 120 patients ont ete soumis a ce protocole en fonction du degre de leur septicite de leur intervention. Le taux global d'infection post-operatoire etait de 6;6 pour cent avec une mortalite de 1;6 pour cent des cas