[Peutz-Jeghers syndrome manifested as massive melæna at CHU-JRA Madagascar hospital: a case report]. / Melæna massif révélant un syndrome de Peutz-Jeghers vu au CHU-JRA Madagascar: à propos d'un cas.

Peutz-Jeghers syndrome (SPJ) is characterized by intestinal hamartomatous polyps in association with mucocutaneous lentiginosis. Patients are exposed to mechanical and bleeding complications. It is a cancer predisposition syndrome. Our study highlights the diagnostic criteria for Peutz-Jeghers syndrome (SPJ), the complications and the therapeutic progresses in patient care. We report the case of a 32-year-old male presenting with a massive melaena. It was hospitalized in the surgical intensive care unit with hypovolemic shock difficult to control. This required surgical intervention to stop bleeding. We found a hamartomatous polyps in the small intestine which caused bleeding. Peutz Jeghers Syndrome was diagnosed on the basis of labial lentigines during childhood. Clinical and paraclinical explorations did not reveal the presence of cancer. In Madagascar, this disease is still poorly understood. In the literature, the diagnosis of Peutz Jeghers syndrome is based on clinical findings or on the presence of complications such as haemorrhage, invagination or bowel obstruction. In our case, the disease was complicated by gastrointestinal bleeding with hypovolemic shock. Endoscopic polypectomy using double-balloon enteroscopy can reduce emergency small bowel surgery. Peutz-Jeghers syndrome is a rare disease. Despite this, it is important for clinicians to know it and to take it into consideration in case of gastrointestinal bleeding.

[Hemodynamic and respiratory conditions of patients with obstetric fistulae operated under spinal anesthesia at the Regional Reference Hospital in Manakara, Madagascar]. / Etats hémodynamiques et respiratoires des opérées de fistules obstétricales sous rachianesthésie au CHRR Manakara, Madagascar.

The objective was to evaluate the hemodynamic and respiratory conditions of patients who had undergone obstetric fistula surgery and to report our experience in the management of these patients. We conducted a descriptive cross-sectional study in the Operating Room and Intensive Care Unit of the Regional Reference Hospital in Manakara from 20 to 30 August 2013. All patients who had undergone obstetric fistula surgery under spinal anesthesia were included in the study. We excluded patients classified as ASA> 2 and those with cardiovascular or respiratory disorders. After pre-anesthetic consultation and preoperative assessments, patients received bupivacaine 12.5 mg with adrenaline 0,5% isobar intrathecal. They were placed in the Trendelenburg position for 5 minutes after the injection of anesthesia and during surgery. Intraoperative sensory level, blood pressure, heart rate, respiratory rate and peripheral capillary oxygen saturation (SpO2) were recorded. 57 patients were retained. The sensory and motor block were excellent in all patients. A metameric level higher than T6 was achieved in 56.36% of patients. Despite a few episodes of hypertension and tachycardia, no patient had respiratory or cardiovascular problems associated with Trendelenburg position. Only sensory level and respiratory rate showed a correlation with Trendelenburg position (p=0,01). This study suggests that Trendelenburg position can be used during spinal anesthesia if an appropriate anesthetic is administered, paying particular attention to changes in position and taking into account the pre-anesthetic examination.

Epidemiological African day for evaluation of patients at risk of venous thrombosis in acute hospital care settings.

INTRODUCTION: This study aimed to identify patients at risk for venous thromboembolism (VTE) among all patients hospitalised, and to determine the proportion of at-risk hospital patients who received effective types of VTE prophylaxis in sub-Saharan Africa (SSA). METHODS: A multinational, observational, cross-sectional survey was carried out on 1 583 at-risk patients throughout five SSA countries. RESULTS: The prevalence of VTE risk was 50.4% overall, 62.3% in medical and 43.8% in surgical patients. The proportion of at-risk patients receiving prophylaxis was 51.5% overall, 36.2% in medical and 64% in surgical patients. Low-molecular weight heparin was the most frequently used prophylactic method in 40.2% overall, 23.1% in medical and 49.9% in surgical patients. DISCUSSION: This study showed a high prevalence of VTE risk among hospitalised patients and that less than half of all at-risk patients received an American College of Clinical Pharmacy-recommended method of prophylaxis. CONCLUSION: Recommended VTE prophylaxis is underused in SSA.

Epidemiological African Day for Evaluation of Patients at Risk of Venous Thrombosis in Acute Hospital Care Settings : Cardiovascular Topic

Introduction : This study aimed to identify patients at risk for venous thromboembolism (VTE) among all patients hospitalised; and to determine the proportion of at-risk hospital patients who received effective types of VTE prophylaxis in sub-Saharan Africa (SSA). Methods: A multinational; observational; cross-sectional survey was carried out on 1 583 at-risk patients throughout five SSA countries. Results: The prevalence of VTE risk was 50.4 overall; 62.3 in medical and 43.8 in surgical patients. The proportion of at-risk patients receiving prophylaxis was 51.5 overall; 36.2 in medical and 64 in surgical patients. Low-molecular weight heparin was the most frequently used prophylactic method in 40.2 overall; 23.1 in medical and 49.9 in surgical patients. Discussion: This study showed a high prevalence of VTE risk among hospitalised patients and that less than half of all at-risk patients received an American College of Clinical Pharmacy-recommended method of prophylaxis. Conclusion: Recommended VTE prophylaxis is underused in SSA