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Aspects épidémiologiques, cliniques et thérapeutiques des luxations de la hanche dans le service de chirurgie orthopédique et traumatologique du CHU- Gabriel TOURE de Bamako
No full textIl s’agissait d’une étude prospective qui s’est déroulée sur 12 (douze) mois mars 2017 à février 2018 et rétrospective de 12 (douze) mois allant de mars 2016 à février 2017 réalisée dans le service de Chirurgie Orthopédique et Traumatologique du CHU Gabriel TOURE.
Cette étude nous a permis d’aboutir aux résultats suivants :
Les consultations pour luxation de la hanche représentaient 2,37% des consultations externes pendant notre période d’étude.
La prédominance a été masculine 69% pour une moyenne d’âge de 28ans.
Les fonctionnaires ont été les plus affectés, les accidents de la voie publique constituaient l’étiologie la plus fréquente, la radiographie standard a été réalisée dans 92,3% des cas.
L’impotence fonctionnelle, la douleur, et l’attitude vicieuse du membre concerné ont été retrouvées dans tous les cas.
96,2% des patients se sont remis après un traitement orthopédique et médical de 6 mois
Prospective cohort study to determine if perioperative mortality at the University Teaching Hospital in Lusaka, Zambia has changed compared to historical data from 1987
No full textThesisDespite low-income and middle-income countries (LMIC) being the regions of the world
with the greatest gap in access to safe surgical and anaesthetic services, there are fewer
published data for these countries on perioperative mortality indices. Global trends are that
perioperative mortality has declined over the last five decades. Zambia has had two
published studies over the last 30 years. The initial study conducted by Heywood, Wilson and
Sinclair in 1987 revealed an overall sixth day inpatient perioperative mortality rate (POMR)
of 7.55 per 1000 operations which was more than three times the current rate of high income
countries. Surgical avoidable POMR was highest at 1.93 per 1000 operations, followed by
administrative avoidable POMR at 0.85 per 1000 operations and then anaesthetic avoidable
POMR lowest at 0.53 per 1000 operations. Some of the recommendations from this study
resulted in the establishment of a trainining programme in anaesthesia and critical care, and
procurement of modern anaesthetic and monitoring equipment. It was the lack of more recent
knowledge to ascertain whether the quality of the Zambian surgical and anaesthetic services
have improved in keeping with global trends that made it imperative to conduct a
perioperative mortality study in the largest teaching hospital in Zambia as a follow up to the
initial study.
Over a six months period we prospectively identified all patients who died within six days of
surgery, having undergone a surgical procedure by either a general, regional or combined
anaesthesia at the University Teaching Hospital in Lusaka. All demised patients had their
records analysed by a specialist surgeon and anaesthetist to determine factors contributing to
their death by consensus. The causes of death were classified as avoidable, partially
avoidable and unavoidable. The deaths categorised as avoidable and partially avoidable were
further categorised into contributing factors, namely anaesthetic, surgical, administrative
cause or a combination thereof. The data on denomenator was collected from the surgical and
recovery room registers. The numerator was the total number of all inpatient deaths within
six days of the surgical procedure, with date of surgery being day one.
A total of 9775 cases were captured with 449 of these being lost to follow up. The
denominator was therefore made of 9326 cases. Seventy nine patients were detected to have
died during the study period. The overall sixth day inpatient perioperative mortality rate
(overall POMR) was found to be 0.85% (95% CI: 0.68-1.06) and the sixth day inpatient
avoidable mortality rate (avoidable POMR) was found to be 0.42% (95% CI: 0.30-0.57). The
sixth day inpatient anaesthetic POMR, surgical POMR and administrative POMR were found
to be 0.04% (95% CI: 0.01-0.079), 0.19% (95% CI: 0.12-0.31) and 0.19% (95% CI: 0.12-
0.31) respectively. Compared to the historical indices from 1987 by Heywood, Wilson and
Sinclair the chi-square test revealed a difference of no statistical significance (x2=0.411 with
1df, p=0.522). With regard to the 24 hour inpatient perioperative mortality indices, the
overall POMR was found to be 0.30% (95% CI: 0.21-0.44). The 24hr inpatient avoidable
mortality rate (avoidable POMR) was 0.17% (95% CI: 0.10-0.28). The 24hr inpatient
anaesthetic, surgical and administrative avoidable POMR were 0.02% (95% CI: 0.00-0.08),
0.07% (95% CI 0.03-0.16) and 0.08% (95% CI: 0.03-0.16) respectively.
The perioperative mortality indices at UTH have not reduced in comparison to the historical
data from 30 years ago. This is contrary to global indices which have shown a downward
trend over the last five decades.
Keywords: perioperative, mortality, numerator, denominator, avoidabl
Les infections par le virus de l’immunodéficience humaine et les virus des hépatites B et C en zone d’instabilité sociale. Cas de Gao
No full textIl s’agit d’une étude descriptive transversale qui s’est déroulé à l’hôpital HANGADOUMBO MOULAY TOURE de Gao, de janvier à décembre 2018 ayant pour But d’étudier les infections par le VIH et les virus des hépatites B et C à Gao, dans un contexte d’instabilité sociale. Au terme de notre étude nous avons recherché le VIH, VHB et VHC chez 2786 personnes. La sérologie VIH était positive dans 1,2% des cas, l’Ag HBs et l’Ac anti VHC étaient présent respectivement chez 7,9% et 0,2% des personnes testées. Le sexe masculin était prédominant dans toutes ces infections. Ces infections sont fréquemment observées entre 20 et 49 ans. Il n’y avait pas des catégories d’occupations spécifiquement atteints. Une coinfection VIH/virus des hépatites était retrouvée chez 0,3% des patients VIH positif. Tous ces patients avaient une coinfection VIH/VHB et dans cas une triple infection VIH/VHB/VHC. L’AEG était retrouvée chez 81,8% des patients hospitalisés
Factsheet,Santé numérique et innovation
No full textLa Santé numérique et innovations a été une stratégie majeure pour le projet kénéya jemu kan financée par l'USAID
Aspects épidémiologiques et anatomopathologiques des cancers broncho-pulmonaires au service d’Anatomie et Cytologie Pathologiques du CHU du point G
No full textRésumé :
Dans cette étude, il a été question pour nous d’étudier les aspects épidémiologiques et anatomopathologiques des cancers broncho-pulmonaires au service d’Anatomie et Cytologie Pathologique du CHU du point G sur une période de 5 ans allant de janvier 2014 à décembre 2018. Les données des patients ont été recueillies à partir des résultats de comptes rendus anatomopathologiques disponibles dans le service. Il en ressort que :
La pathologie est assez fréquente car retrouvée dans 14,08% de l’ensemble des prélèvements broncho-pulmonaires.
Le sexe masculin est le plus atteint.
La pathologie est plus fréquente chez les patients de la tranche d’âge 61-70 ans.
Les ménagères et les retraités étaient les catégories socio-professionnelles les plus représentées.
Les prélèvements provenaient très souvent du CHU du point G.
La biopsie était le type de prélèvement broncho-pulmonaire le plus fréquent.
L’adénocarcinome était le type histologique le plus fréquent.
La maladie présentait une forte mortalité estimée à 74% sur la période d’étude
Transforming the Health Sector in Kenya by Adopting Integrated Health Management Information System
No full texthttp://library.kemu.ac.ke/ijpp/index.php/ijpp/article/view/24Achieving better health outcomes is every health organization’s dream.Several health management strategies have been developed;a key one being production of quality information for purposes of informed decision making.Most public health facilities in Kenya are by large extent using manual health information systems,which are cumbersome and fragmented leading to delayed or uninformed decision making. Five key drivers are viewed to influence Integration of Health Management Information System(IHMIS): i) organizational factor, ii) technical factor, iii) behavioral factor, iv) adopted leadership style and v) operationalization of the functions of management.The purpose of the study was to prescribe an ideal design of an IHMIS.A mixed method research design was adopted to determine the significance of the drivers identified in influencing the IHMIS.Both semi-structured questionnaire and a key informant guide were used to collect data that was analyzed and reported using mean scores,correlation and regression analysis.Integration of HMIS was found to positively and significantly correlate with organizational factor,technical factor,behavioral factor,leadership style adopted and operationalization of the functions of management.The study also showed that all variables accounted for total variation in the integration of HMIS.In a multiple regression analysis,the study found the model valid.However only 4 out of 5 of the predictor variables(operationalization of management functions,behavioral factor,technical factor,leadership style adopted) were good in explaining total variations in the integrated HMIS in Kenya. This implies that the more these variables are improved the better it gets in achieving integration of HMIS which is achievable if all the study variables are taken into account.The study suggests that the ideal design of an integrated HMIS would be in the form of an automated web based system in each health organization as opposed to the current manual system.IHMIS will be more successful,if integration within a single health organization is successful.The study recommends a central database for each level of care
Estimated glomerular filtration rate and C-reactive protein measures enhance the specificity for left ventricular hypertrophy detection using electrocardiographic criteria: paper presented at the 4th Congress of the African Federation of Clinical Chemists; Zimbabwe: 28-30 April 2015
No full textIntroduction: Left ventricular hypertrophy (LVH), the detection of which is recommended for routine risk prediction by all guidelines, is more prevalent in groups of African ancestry. This is in-part attributed to higher prevalence rates of obesity. The detection of LVH using standard electrocardiographic (ECG) criteria (ECG-LVH) has poor sensitivity and specificity and therefore needs modification in groups of African ancestry.
Aim: To assess the usefulness of independent associations between Left Ventricular Mass Index (LVMI) and estimated glomerular filtration rate (eGFR) or serum C-reactive protein (CRP) concentrations to complement ECG criteria for LVH detection in predominantly obese African populations.
Method: LVH determined by ECG using at least 12 different criteria (formulae) was compared to LVH determined by echocardiography (LV mass index>51g/m2.7) in a random sample of 358 participants from a prospective cohort from an urban, developing community of African ancestry in South Africa (41% obese) and used together with CRP concentrations and eGFR above or below the median for the sample.
Results: A combination of CRP concentrations and eGFR above or below the median for the sample respectively showed significant performance (AUC=0.61±0.03, p<0.0005), but a low specificity (ability to report negative results as negative) for LVH detection (77%). When eGFR and CRP concentrations were employed to complement the R wave amplitude of the electrocardiographic lead aVL (RaVL)the specificity increased (93%), although the overall performance did not improve (AUC=0.71±0.03, p<0.0005, RaVL alone: AUC=0.70±0.03). The sensitivity (ability to report positive results as positive) of 25% was however in-line with previously reported sensitivities for LVH detection using ECG criteria in alternative population samples. However, without changing overall performance, eGFR together with RaVL increased the specificity to 88% and CRP concentrations when considered together with RaVL increased the specificity to 87%.
Summary: Routine measurements of CRP and GFR can be used to enhance the specificity of electrocardiographic tests for LVH (especially the RaVL criterion) in obese African patients since these exhibit poor results from ECG alone.
Conclusion: In groups of African ancestry, obesity contributes toward a poor validity and performance of all voltage criteria for the detection of LVH, but the use of eGFR and/or CRP concentrations to complement ECG criteria increases the specificity without altering the overall performance. Learning Outcomes: This study reveals the extra importance and usefulness of routine clinical laboratory tests in enhancing specialist diagnostic procedures
Effects of silver sulfadiazine and actilite honey on bacterial wound colonisation and wound healing in children under twelve years with partial superficial burn wounds at University Adult Teaching Hospital in Lusaka, Zambia
No full textThesisBurn wounds are a global public health concern and Zambia has not been spared. Burn wounds account for 6% of surgical admissions yearly and yet are amongst the common causes of mortality at University Teaching Hospitals (UTH). Burn wounds seen at UTH affect children more than adults and the common size is ≤ 20 per cent and partial superficial thickness in depth. The hospital has no burns unit and as such patients are admitted in general wards where cross infection is not uncommon. With high infection and mortality rates at UTH this study is of importance as it examined the effects of honey and SSD on bacterial wound colonisation and wound healing in paediatric partial superficial burn wounds of ≤ 20 per cent TBSA. This two-arm open label randomised trial was done at UTH over a period of seven months (July 2017-January, 2018). Children under twelve years with ≤ 20% partial superficial burn wounds were recruited. They were then randomly allocated to either honey or SSD group. Demographics were noted on recruitment. Swabs for microbiological evaluation were collected on day 0, 3, 7 and 10 and wounds were assessed for healing. The University of Zambia Biomedical Research and Ethics Committee approved the research. Of the 64 patients, 32 were allocated to each group and showed 1:1 ratio in both groups. The modal age distribution was 1-2 years and the percentage burn wound surface area was 6-10 percent in both age groups. At baseline there was no significant difference in bacterial wound colonisation (80% in honey group and 83% in SSD group; p = 0.74). However, by day 10 on treatment, there was significant reduction in bacterial wound colonisation (Honey Vs SSD; P = 0.026). Wounds treated with Actilite® honey healed quicker than those treated with SSD (Mean 11± 4, 15±6, P=0.0049).The study showed that treatment of children under 12years with partial superficial burn wounds of ≤ 20 per cent TBSA using Actilite® honey significantly reduced levels of bacterial wound colonisation by day 10. It was further demonstrated that wounds treated with Actilite® honey healed at a faster rate compared to those treated with SSD.
Keywords: honey, silver sulfadiazine, burn wounds, wound healing, wound infectio
Prise en charge de l’hypertrophie bénigne de la prostate au service d’urologie à l’hôpital de Ségou
No full textObjectif général :
Etudier l’HBP dans le service d’urologie à l’hôpital de Ségou.
Objectifs spécifiques :
• Déterminer la fréquence hospitalière de l’HBP
• Décrire les aspects cliniques de l’HBP.
• Décrire les aspects para cliniques de l’HBP.
• Analyser les suites immédiates du traitement chirurgical de l’HBP.
• Evaluer le coût de la prise en charge de l’HBP.
Il s’agit d’une étude prospective qui s’est déroulée du 1erjuin 2016 au 30 Juin2017
dans le service d’urologie de l’hôpital de Ségou.
Elle a porté sur 40 malades opérés pour adénome de la prostate.
Sur 1O2uropathies opérées au cours de notre étude ; l’adénectomie prostatique
occupait la première place avec une fréquence de 39 ,2%. L’âge moyen était de
68ans avec des extrêmes de 50ans et 84ans.
La pollakiurie et la dysurie étaient les maîtres symptômes. La rétention aigue
d’urine a été enregistrée chez 92 ,5% de nos malades.
L’échographie vésico-prostatique et rénale a été enregistrée chez tous nos patients.
La seule technique opératoire que nous avons utilisée a été l’adénomectomie
classique Trans vésicale selon Freyer Hryntchak.
Les suites opératoires ont été simples chez 92,5% de nos
malades. La mortalité a été de 2,5%
Morbidité et mortalité néonatale au service de pédiatrie de l’hôpital Nianankoro Fomba de Ségou
No full textIl s’est agi d’une étude transversale et descriptive, qui a été réalisé à l’hôpital Nianankoro Fomba de Ségou, allant du 1er janvier au 31 décembre 2017 et portant sur 475 cas.
Les nouveau-nés âgés de 0-7jours étaient majoritaires dans 89,9 %.
Le sexe masculin était plus fréquent avec 54,9 % des cas, le sex-ratio était de 1,2 et le poids moyen était de 3kg.
La majorité de nos patients était transférée de la maternité de l’hôpital, soit 48 %.
Selon le motif d’hospitalisation, la souffrance foetale aigue était plus fréquente avec 34,5 %, suivie de la prématurité 26,7 %.
La plupart de nos patients venaient hors de la ville de Ségou 54,7 %.
Dans 83,2 % des mères étaient des ménagères, 55,8 % n’étaient pas scolarisées et la plupart était des primipares avec un âge compris entre 17-39ans.
Le nombre de CPN au cours de la grossesse était de 2 CPN avec risque infectieux.
Les nouveau-nés issus d’un accouchement par césarienne étaient majoritaires avec 27,6 % et 4,6 % des nouveau-nés étaient nés à domicile.
Dans 46,7 % de nos bébés avaient une mauvaise réactivité à l’admission.
Selon la technique d’alimentation à l’entrée, 76,2 % de nos nouveau-nés étaient perfusés.
Dans notre étude 4,8 % des nouveau-nés n’avaient pas reçu leur traitement.
Les décès étaient majorés pendant les 3 premiers jours de l’hospitalisation 90 %.
Les nouveau-nés étaient plus fréquents aux mois de Juin, Juillet et Aout.
Le taux de mortalité était de 25,1% et la prématurité était la plus létale avec 47,5 %