African Digital Health Library- University of Ibadan
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A cross sectional study of early functional outcomes of casting of tibial shaft fractures at the university teaching hospitals-adult hospital , Lusaka, Zambia.
No full textThesisTibial shaft fractures are a common presentation following high energy trauma such as
road traffic accidents. The gold standard for the treatment of such injuries is by
Intramedullary nailing, but in a resource-limited setting, the casting of such injuries is
considered as appropriate. At the University Teaching Hospital most tibial shaft
fractures were treated with casting due to several reasons including socioeconomic status
and lack of theatre space.
The functional outcome following such an intervention locally was assumed not to be as
good as alluded to in literature. This was evidence by the indications of most of the
Intramedullary nailing being failed non-operative management. The purpose of this
study was to investigate the early functional outcomes of tibial shaft fractures treated by
casting at the University Teaching Hospital. The results of the study will guide the
rationale of continuing on the current path of treatment locally.
Using a cross-sectional analysis, participants at three months post-injury with tibial shaft
fracture presenting to the orthopedic clinic for their scheduled review appointment were
randomized and 138 were enrolled and assessed using the Johner- Wruhs criteria. The
results of this study were examined against those stated in the literature.
The 138 participants comprised 102 (73.9%) males and 36(26.1%) females with an age
range of 19-64years. The median age was 34.5 (IQR14).
The result of the study showed that 75.4% of the participants had good to excellent
results following casting at three months post-injury. Fair to poor results was seen in
24.6% of the participants
The study demonstrates that the results of tibial shaft fractures treated with casting at the
UTH are good. It is in tandem with the results that are shown in similar studies done
elsewhere in a similar socioeconomic setting.
Keywords: Functional outcomes; intramedullary nailing; Johner- Wruh criteria;
Casting
Effectiveness of cefotaxime in preventing surgical site infections in children under 8 years undergoing elective inguinal surgery at the university teaching hospitals, Lusaka, Zambia
No full textThesisInguinal operations are the most commonly performed surgeries in children. There is a divergent view on use of pre-operative antibiotic prophylaxis to prevent surgical site infections (SSI) after these surgeries. The aim of this study was to detect if the use of cefotaxime had a significant impact on prevention of SSI in children under 8 years undergoing elective inguinal surgery at the University Teaching Hospitals, Lusaka.
This was a cohort study. A total of 170 patients below 8 years of age undergoing elective inguinal herniotomy, orchidopexy or patent processus vaginalis (PPV) ligation at UTHs were enrolled. 85 of these received pre-operative cefotaxime while 85 did not receive any antibiotics based on surgeons preference. A data collection sheet was used to record pre-operative demographic details. Intraoperative variables and post-operative outcomes. No patient received post-operative antibiotics. Follow up to look for Surgical site infection was done at 2 weeks and 30 days according to Center for Disease Control (CDC) definition of SSI.
Out of 170 patients, 11(6.47%) had SSI. Six of the 85 that received surgical antibiotic prophylaxis (SAP) had SSI while 5 of the 85 that did not receive SAP had SSI (P=0.551). Deep SSI were seen in 2 patients that did not receive SAP (p=0.155) and grew Staphylococcus aureus in their cultures. Only 1 adverse allergic reaction to preoperative antibiotics was noted.
Despite a low risk of adverse reactions, there is no benefit of using pre-operative antibiotics to prevent SSI in children undergoing elective inguinal surgery.
Keywords:
Surgical site infections, Surgical antibiotic prophylaxis, Inguinal surgery, PPV ligation, Herniotomy, Orchidopex
Les cancers colorectaux dans le district de Bamako de 2015 à 2019
No full textRésumé
Notre étude avait pour but d’étudier les aspects épidémiologiques et histopathologiques des cancers colorectaux à Bamako de 2015 à 2019 à partir des données du registre des cancers. Il s’agissait d’une étude rétrospective et transversale, allant du 1er Janvier 2015 au 31 décembre 2019 soit une durée de 5 ans. Cette étude nous a permis d’obtenir 636 cancers colorectaux dans le district de Bamako sur un total de 10 597 cancers soit une fréquence de 6%. L’incidence est de 7,9 pour 100 000 habitants. L’âge moyen de nos patients était de 53,11±19,44 ans avec des extrêmes de 3 et 99 ans. Les données provenaient de deux principales structures : le CHU du point G (52,7%) et le CHU du Gabriel Touré (14,2%). La confirmation histologique et cytologique (83,5%) a été faite par le service d’anatomie cytologique et pathologique du CHU du point G. La localisation colique était la plus fréquente avec 52,6%
A cohort study on early outcomes of femur shaft fractures in adults treated by interlocking intramedullary nails at the university teaching hospital, Lusaka.
No full textThesisThe management of femur shaft fractures has evolved from the historical non-operative methods to the most recent intramedullary nail fixation. Interlocking nails have broadened the roles for closed intramedullary nailing of femur fractures. Early ambulation after fractures of the femur shaft has been shown to have a significant advantage in terms of both joint mobility and economic impact, which are very well attained by the use of interlocking nails. Shortening of the limb and malalignment along with contractures of the knees due to prolonged immobilization have traditionally plagued the Orthopaedic surgeons’ management of patients with these injuries.
The proportion of Femur shaft fractures seen at the University Teaching Hospital (UTH) is anecdotally high. In keeping with this, the use of interlocking nails has equally increased. However, the outcomes of the use of interlocking nails in this setting are not documented. This study looked at the early outcomes of femur shaft fractures treated by interlocking intramedullary nails at UTH. Femur shaft fractures are serious injuries that generally result in short-term disability and pain; but also have a high risk of long term deformity and disability. This study was aimed at evaluating the early outcomes of using interlocking intramedullary nails in the treatment of patients with closed femoral shaft fractures at the University Teaching Hospital, Lusaka. The objective was to explore the early outcomes of closed fractures of the shaft of the femur that were treated using interlocking intramedullary nails at the University Teaching Hospital, Lusaka.
The study was a prospective cohort study carried out between August 2019 and February 2020 at the University Teaching Hospital, Lusaka. During this period, a total of 63 patients that underwent interlocking intramedullary nailing were followed up for 6 weeks. The study participants were evaluated using the Thoresen criteria for short term outcomes.
The rotational deformity was the most prevalent outcome, with 68% of participants having rotational deformity, external rotation was the most common (40%) deformity. There was a statistically significant correlation (p-.006) between comminution and rotational deformity. Infection was very low, as only one participant (1.6%) had recorded a superficial infection. A limb shortening prevalence of 59% was found in this study, significant shortening (more than 2cm) was 7.9%. However, 92 per cent had combined good or excellent Thoresen outcome scores. An overall knee flexion of less than 90 degrees was found in 24% of the patients in this study.
The early outcomes of treatment using interlocking IMN for femur shaft fractures at UTH is good to excellent (based on the Thoresen score criteria) in terms of limb length discrepancy, rotational deformity and knee flexion combined. The proportion of post-surgery infection among patients with femoral shaft fracture treated with interlocking IMN was low (1.6% -superficial infection)
TAP Bloc dans la prise en charge de la douleur en chirurgie sous ombilicale : Expérience du CHU Point G
No full textLe TAP bloc à une place indéniable dans l’arsenal de nos techniques d’analgésie multimodale en chirurgie abdomino-pelvienne. Il procure une analgésie postopératoire de qualité et permet une épargne morphinique substantielle. Du fait de son efficacité, de sa simplicité d’exécution, et de son faible taux de complication, sa popularité devrait être croissante.
Notre étude a démontré les bénéfices du TAP Bloc dans les programmes d’analgie post opératoire. En effet, nous avons réalisé qu’au niveau de la gestion de la douleur postopératoire, le TAP bloc a donné d’excellents résultats avec une maitrise de la douleur jusqu’au-delà de 8heures de temps dans le postopératoire. Il nous a permis d’avoir comme résultat, une diminution de la consommation des morphiniques et opioïdes en postopératoire ainsi qu’une réduction de la charge de travail du personnel soignant avec une possibilité de réhabilitation post opératoire précoce
A study of acute pain after cesarean section - incidence and associated factors, at the university teaching hospital, Lusaka, Zambia.
No full textThesisBackground: Some 4,200 caesarean sections were done at the University Teaching Hospital (UTH), Lusaka between September 2015 to September 2016. A 2007 study cited pain was as one of the complications. However, the incidence and possible associated factors to pain after a caesarean section was not evaluated further in that study. The incidence of pain after caesarean section is reported high elsewhere. Caesarean section is an essential life-saving and common surgical procedure. Pain as one of its complication should be well understood to avoid the suffering of patients. There is no data locally on the incidence of acute pain after caesarean section and its associated factors. This study set out to determine the factors associated with acute pain after caesarean section at UTH, Lusaka, Zambia.
Methodology: The study was set out to determine the incidence and associated factors of acute pain after elective caesarean section at UTH, Lusaka, Zambia. It was a prospective, cross-section, observational study involving two hundred and forty-six parturients that had a caesarean section at UTH, Lusaka, Zambia. The study lasted for five months and all women who were undergoing elective caesarean section and gave consent were included. All emergency caesarean sections, patient who was taken to the intensive care unit, high dependence unit, who had altered mental state and those who did not give consent were excluded. Consecutive sampling was used to select participants. Information was obtained at 24-hours post-caesarean on socio-demographic, pregnancy and pain management and pain assessed using the Wong-Baker Score. Data were entered into an excel spreadsheet and then analysed using SPSS version 22.0. Chi-square was used to determine the association of independent factors to the dependent factor (Wong-Baker Score). Multiple logistic regression analysis was used to control for confounders and determine factors associated with acute pain 24-hours after caesarean section.
Results: The age range of the 246 participants was from 16 years to 45 years. Eighty-four participants had no pain (34.1%), 71 (28.9%) had mild pain, 63 (25.6%) had moderate pain and 28 (11.3%) had severe pain. On bivariate analysis, administration of pethidine, paracetamol and diclofenac was associated with low pain scores. The grade of the surgeon, age of the participant, previous surgery, previous caesarean section, history of dysmenorrhea, joint pains, headache, backache, bilateral tubal ligation, level of education, the expectation of pain, anxiety or depression were not associated with acute pain. On multivariate analysis, only a history of the previous caesarean was associated with moderate-severe pain: OR 0.47 (95%CI 0.26-0.84, p=0.0101).
Conclusion: The incidence of acute pain at UTH, Lusaka, was significant - over one-third (36.9%) complained of moderate to severe pain at 24-hours based on the Wong-Baker Score. A history of previous caesarean section was the only factor that was associated with moderate to severe pain. However, the odds ratio <1 implied those with a previous caesarean had less association with moderate to severe pain. More research is needed to optimize pain relief after caesarean section.
Keywords: Caesarean section, Pain scores, Wong-Baker Scor
Epulis gingivale congénitale : à propos d’un cas et revue de la littérature
No full textIntroduction : l’épulis congénitale est une tumeur bénigne de la muqueuse alvéolaire du maxillaire du nouveau-né. Elle a été décrite pour la première fois par Neumann en 1871. C’est une pathologie rare avec une incidence de 0,0006%. Elle peut engendrer des troubles respiratoires ou alimentaires. Le traitement est chirurgical, le pronostic est favorable.
Objectif : illustrer la rareté de l’épulis congénitale dans notre pratique à travers une observation clinique et faire une revue de littérature.
Observation : Il s’agissait d’un nouveau-né à J1 post-natal, de sexe féminin, adressé par la pédiatrie pour une difficulté de succion sur une masse gingivale supérieure et inférieure mesurant, respectivement, environ 7x3 cm et 2x1,5 cm, indolore, de consistance ferme et mobile. Cette masse a fait l’objet d’une exérèse chirurgicale dont les suites opératoires ont été simples avec un recul de six mois sans récidive, ni anomalie dentaire.
Discussion : L’épulis congénitale est une tumeur bénigne rare prédominant chez le nouveau-né de sexe féminin avec un sex-ratio de 10:1. Les formes volumineuses ou multiples peuvent engendrer une gêne respiratoire et/ou alimentaire. Elle se présente comme un polype solitaire fermement attaché à la face labiale de crête alvéolaire et elle est 2 à 3 fois plus fréquente sur le maxillaire supérieur que sur la mandibule. Le diagnostic anténatal est possible par l’imagerie foetale. L’histologie retrouve des cellules polygonales ou allongées à cytoplasme éosinophile et granulaire. Le traitement de choix est l’exérèse chirurgicale. Les récidives sont rares et la dégénérescence maligne n’a pas été rapportée ; une anomalie de l’éruption dentaire est possible.
Conclusion : L’Epulis congénitale est une tumeur bénigne et rare du maxillaire du nouveau-né pouvant entrainer des troubles respiratoires ou alimentaires. Le diagnostic est clinique et anatomo-pathologique. La prise en charge est multidisciplinaire et le pronostic est excellent
A study of the john Cunningham virus (jcv) seroprevalence among Zambian adults presenting with “meningoencephalitis” to the university teaching hospital, Lusaka, Zambia
No full textThesisThe John Cunningham virus (JCV) is an opportunistic virus, which leads to the
development of progressive multifocal leukoencephalopathy (PML). Infection with the
JCV occurs in childhood and the virus remains quiescent in the body, activating during
immunosuppression. Exposure to the virus can be detected by testing for JC virus
specific antibodies in an ELISA test. One of the major unanswered questions of JC virus
epidemiology is whether it is less frequent in Africa than in the West. Our aim was to
determine the JCV seroprevalence and factors associated with its positivity among
Zambian adults presenting to the University Teaching Hospital (UTH) with suspected
meningoencephalitis and to assess the JCV ELISA test as a possible tool for PML risk
stratification.
This was a cross sectional nested study in the TB meningitis in Zambia (TMZ) study
which looked at improving ways of TB diagnosis in patients with meningoencephalitis.
It included adults 18 years and older who presented with suspected meningoencephalitis
and had undergone a lumbar puncture as part of their evaluation. Confirmed PML cases
were also recruited based on clinical features, confirmed by JCV DNA PCR of CSF.
Data was analysed using Epi Info 7. Descriptive statistics were used to determine patient
characteristics and JCV seroprevalence and compared using chi-square tests. Multiple
logistic regression was used to determine the significance of factors associated with JCV
positivity as well as for stratifying PML risk by comparing features of the HIV positive
JCV positive group with confirmed PML cases.
Final analysis for JCV seroprevalence was done in 96 patients and noted to be 46%
(95% CI, 35.62 – 56.31). The JCV seroprevalence in the HIV positive group was
40.82% and in the HIV negative group was 51.06 % but there was no statistical
difference (p-value 0.31). None of the other factors studied had any impact on the JCV
seroprevalence. There was a bimodal distribution of age associated with JCV
seropositivity; with one peak occurring in the 18 to 20 years age group and the second
peak occurring in the 55 to 60 years age group. 14 (3.2%) confirmed PML cases, based
on clinical features and JCV DNA CSF positive, were all JCV seropositive and HIV
positive with advanced immunosuppression (CD4<200/mm3). Memory impairment was
associated with a 6 fold increased likelihood of having PML in advanced HIV disease
with JCV which further, increased to over 20 fold after adjusting for age , gender and
TBM diagnosis. After adjusting for other variables TBM was associated with an 87%
less likelihood of having PML (p-value 0.03). Female gender was associated with
increased risk of having PML (p-value 0.02) and a younger age was protective for PML
(p-value 0.03).
The prevalence of anti-JCV antibodies in patients with suspected CNS infection
(meningoencephalitis) was 46%. Anti- JCV antibody prevalence did not differ
significantly by age, gender, HIV status or CD4 count. Memory impairment in JCV
seropositive, advanced HIV disease patients with meningoencephalitis was the most
important variable associated with having PML. After adjusting for other variables, male
gender, a younger age and diagnosis of TBM were protective of having PML.
Key words: John Cunningham Virus (JCV), Progressive Multifocal Leukoencephalopathy (PML
Rupture utérine : aspects épidémio-cliniques, thérapeutique et pronostic au centre de santé de référence de Bougouni
No full textNous avons réalisé une étude cas-témoins allant du 1er Janvier au 31 Décembre 2019 dans l’unité de Gynécologie-Obstétrique du centre de Santé de Référence de Bougouni. Toutes les patientes prises en charge dans le service pour rupture utérine ont été incluses et deux témoins (accouchement par voie sans rupture) pour un cas (rupture utérine).
Les données ont été saisies et analysées sur le logiciel SPSS version 21. Le seuil de significativité a été fixé à 5%. L’association entre 2 variables qualitatives a été étudiée par le Chi².
Nous avons enregistré 43 cas de rupture utérine sur un total de 1161 accouchements soit une fréquence de 3,7%.
Les facteurs de risque ont été dominés la cicatrice de césarienne(p=0,038) ; OR=2,99, le non suivi de la grossesse(p=0,002) et la résidence en milieu rural(p=0,000) et l’intervalle intergénésique ≤ 2ans (Khi-deux = 9,1735 ; p = 0,002)
Le pronostic materno-foetal est réservé avec 1 cas de décès maternel soit 2,3% et 28 cas décès périnatal soit 65,1%