Long-term prognosis of patients with permanent cardiac pacemaker indication in three referral cardiac centers in Cameroon: Insights from the National pacemaker registry.

BACKGROUND: There is evidence that cardiac pacemakers improve symptoms and quality of life in patients with severe bradycardia. Globally, the number of pacemaker implantations is on the rise. However, the associated high-cost limits pacemaker's accessibility in low resource settings. This study aimed to investigate access to pacemakers and the long-term outcome of patients requiring a pacemaker. METHOD: We conducted a cohort study in 03 health care structures in Cameroon. Participants aged at least 18 years with indication for a permanent pacemaker between January 2010 and May 2016 were included. Clinical profile, electrocardiography, pacemaker implantation parameters were recorded. Long-term survival was studied by event-free analysis using the Kaplan-Meier method. RESULTS: In total, 147 participants (mean age 67.7±13.7 years, female 58.5%) were included. Fatigue (78.7%), dyspnoea (77.2%), dizziness (47.1%) and palpitations (40.4%) were the main symptoms while syncope was present in 35.7% of patients. The main indication for cardiac pacemaker was atrioventricular block (85.3%). Forty (27.2%) could not be implanted with 34 (85%) of participants highlighting cost of intervention as main reason. VVIR was the main mode of stimulation (70.5%). Of 125 patients in which follow-up was ascertained, 17(13.5%) died after a median survival time of 2.8 years post diagnosis [IQR: 1.8-4.2]. The survival curve was better in participants with a pacemaker with a Hazard ratio of 2.7 [CI: 1.0-7.3, P=0.045]. CONCLUSION: Our patients with severe heart blocks presented late and more than a quarter did not have access to pacemaker but its implantation multiplied the survival rate by 2.7 times at approximately 3 years post diagnosis. Improving early detection of heart blocks and access to cardiac pacing to reduce mortality shall be a key future priority.

[Acute colonic diverticulitis : outcome according to general practice management prior to referral and criteria predictive of complications. A 10-year experience in a University Hospital]. / Diverticulite aiguë du colon : devenir en fonction de la prise en charge préalable en médecine générale et critères prédictifs de complications. Expérience sur 10 ans dans un C.H.U.

INTRODUCTION: Ambulatory treatment of acute uncomplicated diverticulitis has been shown to be safe and effective by several recent studies. The aim of our study was to analyze the outcome of general practice management concerning the complications, the treatment modalities and the hospitalization duration during the first episode of acute diverticulitis. MATERIEL AND METHODS: A total of 176 medical files of patient presenting between January 2000 and December 2010 at the emergency department with a first episode of acute diverticulitis confirmed by an abdominal CT scan were analyzed. Among the 160 patients fulfilling the inclusion criteria, 50 were referred by a general practitioner (GP). Data concerning admission modalities, clinical status, paraclinic investigations, complications, treatment and length of hospital stay were reviewed. RESULTS: The patients referred by the GP were significantly older (p ⟨ 0.001) and were hospitalized significantly longer (p = 0.034) than the patients consulting directly the emergency department. There was a significant correlation between the 2 variables (R = 0.406). Complications and treatment modalities did not differ between the two groups. Complicated diverticulitis was associated with rebound (p = 0.049), tenderness (p = 0.005) and a time interval between initial symptoms onset and admission to the emergency department superior to 4 days (p = 0.027). CONCLUSIONS: Ambulatory management of acute diverticulitis by the GP does not affect the outcome of the patients after their hospital admission in term of complications and treatment modalities. Ambulatory treatment of acute diverticulitis is safe but hospitalization is indicated in case of poor clinical tolerance, presence of rebound, tenderness and duration of symptoms for more than 4 days.

INTRODUCTION: Le traitement ambulatoire des diverticulites non compliquées est efficace et recommandé dans plusieurs études. Le but de notre étude était d'analyser l'impact de la prise en charge en médecine générale sur les complications, les modalités de traitement et la durée d'hospitalisation lors d'un premier épisode de diverticulite. MATERIEL: 176 dossiers ont été analysés. Parmi les 160 patients retenus, 50 étaient adressés par un médecin traitant. Les critères d'inclusion étaient : admission via les urgences avec un premier épisode de diverticulite confirmé par au moins un CT scanner. Les données analysées étaient l'anamnèse, les paramètres cliniques et paracliniques, les complications, les traitements et la durée d'hospitalisation. RESULTATS: Les patients adressés par le médecin traitant ont une durée d'hospitalisation plus longue (p = 0,034) et sont plus âgés (p ⟨ 0,001) que ceux se présentant directement aux urgences avec une corrélation significative entre les 2 variables (R = 0,406). Aucune différence significative n'a été retrouvée en termes de complications et de modalités de traitement entre les deux groupes. Le rebond (p = 0,049), la défense (p = 0,005), et un délai entre le début des plaintes et l'admission aux urgences supérieures à 4 jours (p = 0,027) étaient les facteurs associés à une diverticulite compliquée. CONCLUSION: La prise en charge en médecine générale des diverticulites aiguës ne modifie pas le devenir des patients lors de leur admission à l'hôpital en termes de complications et de modalités de traitement. Le traitement ambulatoire des diverticulites simples est recommandé, mais en cas de mauvaise tolérance clinique, telle que la présence d'un rebond, d'une défense et des symptômes de plus de 4 jours, une hospitalisation est indiquée et justifiée.

[Ballistic concepts and management of gunshot wounds at members]. / Notions de balistique et prise en charge des plaies par balle au niveau des membres.

Ballistic trauma is not the prerogative of battlefields and currently extends to civil environments. Any surgeon or emergency room can be faced with such trauma whose management requires an understanding of wound ballistics. The aim of this retrospective is reviewing the management of ballistic trauma within the C.H.U. Saint-Pierre hospital over a period of ten years. Data recorded included demographics data, lesions, clinical parameters, imaging, treatment and outcome. It appears that the wounds of the members have a low mortality rate but a significant rate of complications. Patients should be managed according to the ATLS protocol and according hemodynamic stability and location of the injury, benefit from imaging. Unstable patients will be operated in emergency, stable patients will be treated according to the extent of damage and the type of fracture either conservatively or by external fixator and intramedullary centromedullary. Debridement and antibiotics are recommended as a nerve exploration if there is a peripheral paralysis. The management of trauma in our sample appear not optimal in light of the literature especially in terms of setting the vascular point of debridement, antibiotic and nerve repair resulting in significant consequences. Two management protocols according to patients' hemodynamic status are offered.

La traumatologie balistique n'est pas l'apanage des champs de bataille et s'étend actuellement de plus en plus aux milieux civils. Tout chirurgien ou urgentiste peut se trouver confronté à de tels traumatismes dont la prise en charge est spécifique et nécessite notamment une connaissance en balistique lésionnelle. Cette étude consiste en une revue rétrospective de la prise en charge des traumatismes balistiques au sein du C.H.U. Saint-Pierre sur une période de dix ans. Les données démographiques, lésionnelles, cliniques, d'imagerie, de traitement et de suivi ont été collectées. A l'analyse des dossiers, il ressort que les plaies des membres ont un faible taux de mortalité, mais un taux de complications non négligeable. Les patients doivent être pris en charge selon le protocole ATLS puis selon la stabilité hémodynamique et la localisation du traumatisme, bénéficier d'une imagerie. Les patients instables seront opérés en urgence sans imagerie, les patients stables présentant des traumatismes osseux seront traités selon l'importance des lésions et du type de fracture soit de manière conservatrice, soit par fixateur externe ou enclouage centro-médullaire. Un débridement et une antibiothérapie sont recommandés ainsi qu'une exploration nerveuse s'il existe une paralysie périphérique. La prise en charge des traumatismes dans notre échantillon n'apparait pas optimale à la lumière de la littérature notamment en termes de mise au point vasculaire, de débridement, d'antibiothérapie et de réparation nerveuse. Deux protocoles de prise en charge selon l'état hémodynamique du patient sont proposés afin d'optimaliser la prise en charge.

[Furuncular myiasis: Case report of a cutaneous parasitosis usually considered as an abscess]. / La myiase furonculeuse: Cas clinique d'une parasitose cutanée souvent confondue avec un abcès.

Furuncular myiasis is a wel l established cutaneous parasitosis in tropical area. In Europe, most of cases have been described in patients returning from risk areas. We report a case of a 4-year old child with a furuncular lesion on his left thigh considered as an abscess and who was send to emergency department for surgical drainage.

La myiase furonculeuse est une parasitose cutanée bien connue dans les régions tropicales. En Europe, des cas rares ont été décrits chez des patients ayant séjourné dans les zones à risque. Nous rapportons le cas d'un enfant de 4 ans présentant un furoncle au niveau de la cuisse gauche considéré à tort comme un abcès et envoyé aux urgences pour drainage.

Penetrating cardiac injuries in Belgium: 20 years of experience in university hospitals in Brussels.

BACKGROUND: Cardiac wounds remain as highly lethal lesions in which their prognosis depends on the emergency management. OBJECTIVES: The aim of this study is to analyse experiences of cardiac surgeons in different hospitals in Brussels and compare it with the findings in the literature. METHODS: From 1st January 1990 till 1st December 2010, all penetrating cardiac wounds in three Brussels hospitals were retrospectively reviewed. Data recorded included clinical parameters, surgical constatation and outcome. RESULTS: A total of fourteen (12 male/2 female) patients sustained penetrating cardiac injuries. There were thirteen patients (93%) with stabs wounds and, one patient (7%) with gunshot wound. Wound locations are as follows: ten patients (71%) right ventricle, three patients (22%) the pericardium, and one patient (7%) the left ventricle. The hemodynamic status was unstable in nine patients (64%), in-extremis in two patients (14%) and stable in three patients (22%). The mean Abbreviate Injury Score was 4.6 and the mean New Injury Severity Score was 31. Thirteen patients (93%) had operations (11 sternotomie, 2 thoracotomies). Two patients required cardiopulmonary bypass. Three patients (22%) died. CONCLUSION: Penetrating cardiac wounds are relatively rare in Belgium, which is mainly due to stabs and with consequent mortality. The implementation of clear guidelines is necessary to improve survival.

Predictors of early outcome after acute appendicitis: is delaying surgery for acute appendicitis an option? A retrospective study.

PURPOSE: This study analysed the clinical and para-clinical criteria that may allow surgeons and emergency physicians to take a decision regarding the surgery of acute appendicitis. METHODS: A retrospective analysis was conducted on 284 acute appendicitis patients who underwent surgery between January 2007 and December 2009 in our institution. The registered data were extracted from patient files and statistically analysed. These data included past medical history, clinical, laboratory and imaging data, duration of hospital stay and post-operative complications. Patient delay (time between the appearance of symptoms and patient arrival at the emergency department) and hospital delay (time between hospital arrival and operation) were correctly investigated. Statistical analysis was done by using SPSS software. RESULTS: The patient delay is significantly increased in relation to the severity of appendicitis: 24 h (10.8-30.8 h) versus 37.4 h (36.8-38 h) (P < 0.05), unlike hospital delay, which remains constant (between simple and severe appendicitis): 7.5 h (5-14.8 h) versus 8 h (5-13 h). In severe appendicitis, the proportion of guarding, rebound tenderness, tachycardia (P < 0.05) and fever (P < 0.005) were significantly high, and leucocytosis (P < 0.05), C-reactive protein (CRP) (P < 0.001) and eosinopaenia [37.0 vs. 72.8 (P < 0.001)] were significantly different. Concerning computed tomography (CT) and echography, perforation, abscess formation (P < 0.05), phlegmon (P < 0.005) and peritonitis (P < 0.05) were significant signs of complicated cases. The length of hospital stay (P < 0.001) and duration of antibiotic therapy (P < 0.001) were statistically significant in cases of complicated appendicitis. CONCLUSION: Patient delay is a determining factor for the grade of appendicitis. It has an influence on the complications, length of hospital stay and duration of antibiotic treatment, unlike hospital delay.

Indications; complications; et resultats des colostomies transverses a l'hopital general de Douala; Cameroun

Introduction : Une stomie digestive peut etre realisee a partir de l'ileon; du colon ascendant; transverse ou descendant. Elles peuvent etre laterales ou terminales. L'etude s'interesse plus particuliere-ment des colostomies transverses afin d'evaluer leur frequence parmi les autres stomies laterales realisees pendant une periode de 10 ans a l'hopital general de Douala dans le meme service de chirurgie digestive dans Le but d'etudier retrospectivement leurs indications tout en faisant enfin une evaluation critique de cette pratique. Methodes :De decembre 1999 jusqu'au mois de decembre 2009 nous avons recense tous les patients ayant beneficie d'une stomie laterale en relevant les caracteristiques cliniques des porteurs d'une colostomie transverse; ainsi que des complications majeures et mineures repertoriees par le personnel infirmier.Resultats :110 colostomies laterales effectuees; 72(68) de colostomies transverses; l'age moyen etait 69;5ans (24-95); le sexe ratio h/f etait de 0;8. elles avaient ete realisees en urgence dans 60 cas et dans le meme temps temporaires. L'occlusion aigue colique pour (43;1) des cas a constitue notre indication majeure. Le taux de complications specifiques etait de 44 et d'une part (32) de cas de prolapsus stomial comme complications majeures Puis (9;7) d'eventrations parastomiales et les retractions stomiales observees dans (7) de cas; aucune ischemie ou necrose n'ayant pas ete observee. Conclusion : L'occlusion aigue du colon justifie une indication d'une colostomie transverse en urgence comparativement aux autres stomies; elle semble comporter moins de complications a type de necrose et d'ischemie par rapport aux Stomies laterales

[Cardiac surgery in Cameroon. Results at one year of the pilot phase]. / Chirurgie cardiaque au Cameroun. Résultats à un an de la phase pilote.

In the framework of implementation of his national program for control and prevention of cardiovascular diseases, Cameroonian government has set up a cardiac surgery project. We report in this manuscript results of one year follow up of the patients operated during the pilot phase. From September 22 till 26, 2008, 11 patients have been operated in Cameroun. Surgical procedures were 5 mitral mechanic valve replacement, 2 aortic mechanic valve replacement, 1 atrial septal defect closure, 2 pace maker implantation. No intrahospital death was observed. One patient died at 11th month after the operation due to mitral valve thrombosis and attributed to lack of compliance. One patient presented low cardiac output, pneumonia and a pleural effusion. 2 patients presented 2 minor complications consisting of pericarditis and superficial wound infection. The results of the pilot phase of cardiac surgery in Cameroon are effective. However, the sustainability of the program require human, material capacity building, and funding mechanism as well.