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Impatto della telepatologia sull’attività chirurgica in un ospedale rurale africano: rationale, problematiche e risultati
Get PDFIntroduzione.
La telemedicina è una realtà nei paesi occidentali ma può avere una valida applicazione anche nei paesi a risorse limitate. La telepatologia in particolare può rappresentare una valida soluzione per migliorare la qualità dell’assistenza specialmente dove gli anatomopatologi sono pochi o mancano del tutto.
Obiettivo: L’obiettivo generale di questa ricerca è stato quello di verificare la fattibilità e il reale impatto di un servizio di diagnostica istopatologica in telepatologia sul trattamento dei pazienti affetti da neoplasie ricoverati presso un ospedale rurale dell’Africa sub-sahariana.
Obiettivi specifici :
- valutare le risorse materiali ed umane utilizzate per il funzionamento del servizio di telepatologia ;
- descrivere i risultati delle attività svolte dal servizio di telepatologia durante i primi due anni ;
- proporre eventuali miglioramenti.
Materiale e Metodi
A seguito dell’elaborazione del progetto in collaborazione con i partner tecnici e finanziari nel 2015, la messa in opera del servizio di telepatologia è durata circa 12 mesi. Sono state prese in considerazione le problematiche relative agli aspetti finanziari, alla disponibilità delle risorse ed i risultati attesi.
E’ stata eseguita una valutazione preliminare delle aspettative e delle eventuali perplessità del personale sanitario in merito all’adozione della telepatologia, provvedendo contestualmente a fornire opportune informazioni.
Lo scanner acquisito è stato lo Hamamatsu NanoZoomer 2.0-RS C10730.
Il personale locale è stato opportunamente formato ed è stato creato un registro in Excell dei pazienti esaminati. Sono stati quindi contattati e coinvolti dei patologi per la lettura dei vetrini a distanza attraverso una piattaforma informatica creata presso l’Hôpital de Zone Saint Jean de Dieu di Tanguiéta.
Sono stati quindi valutati i risultati in termini di numero di esami istologici e tipologia delle patologie identificate.
Risultati.
Sono stati esaminati mediante telepatologia 1097 pazienti durante i primi due anni del progetto. 556 erano uomini e 541 donne, l’età media è stata di 41,5±19,9 anni (range 5 giorni- 88 anni). I prelievi istologici sono stati eseguiti praticamente a carico di tutti i tessuti ma in particolare nel 31,4% dei casi nel distretto uro-genitale, nel 14,2% a livello muscolo-cutaneo, nel 12,4% sulla mammella e nel 10,8% a carico dell’intestino.
I tumori benigni hanno rappresentato il 38,6% delle diagnosi mentre le neoplasie maligne il 35,9%. L’intervallo di tempo tra l’invio delle immagini istologiche e la risposta del patologo è stato in media di 8±7 giorni. Per quanto riguarda la primitività delle neoplasie maligne, quelle a partenza dall’apparato urogenitale sono state le più frequenti (26,6%), seguite da quelle della mammella (20,1%) e del sistema linfo-splenico (13.7%). L’età media dei pazienti al momento della diagnosi del tumore maligno era di 42,5±20,1 anni. Per quanto riguarda le neoplasie della mammella, sono state identificate 136 neoformazioni. Di queste 79 (58.1%) erano neoplasie maligne e tutte le pazienti sono state sottoposte a trattamento chirurgico definitivo (quadrantectomia/mastectomia con linfoadenectomia).
Queste pazienti rappresentano il 20.1% dei casi di cancro diagnosticati per mezzo della telepatologia a Tanguièta dal 2016 al 2018, quindi 1/5 di tutte le neoplasie.
L’età media delle pazienti al momento della diagnosi era di 46.1± 13,5 anni con un range di 21-75.
Conclusioni.
La telepatologia è sicuramente una tecnologia con un impatto estremamente significativo sulla qualità dell’assistenza. I risultati ottenuti riguardano non solo il numero di esami istologici eseguiti ed eseguibili ma anche l’accuratezza delle diagnosi, la rapidità delle risposte e soprattutto la migliore definizione della strategia terapeutica da adottare in ogni singolo paziente.
Riteniamo inoltre che la creazione di un servizio di telepatologia dovrebbe trovare maggiore diffusione nel contesto dei PVS, a livello Dipartimentale ma anche a livello nazionale. Requisito essenziale per la realizzazione di un servizio di telepatologia è la continuità assistenziale e funzionale della struttura ospedaliera che ne viene dotata, sia per quanto riguarda la formazione del personale dedicato sia per la necessità di costruire e garantire un network di patologi disponibili a collaborare
acute generalized peritonitis in a peripheral hospital centre in Benin. Can it be managed by a local general practitioner?
Get PDFBackground. Acute generalized peritonitis in resource-poor countries is still a health challenge due to late diagnosis, surgical delay,
and specialists’ unavailability. %ese are the foremost determinants of surgical morbidity and mortality. We report the experience
of a peripheral hospital in Benin not equipped with specialized surgeons. Methods. %is is an observational, retrospective, and
descriptive study including patients operated for acute generalized peritonitis at the Atacora Departmental Hospital Centre,
Benin, where unfortunately CTscan and intensive care unit are still not available. Most of surgical activities were performed by a
general practitioner with previous surgical training (but no surgical specialization). Age, gender, cause of peritonitis, surgical
procedures, and postoperative outcome were evaluated. Results. Sixty-three patients were included. %e mean age was 23.2 years
and sex ratio M/F 1.5. %e mean surgical delay was 26 hours (range: 6–92 hours). An ileal typhoid perforation was found in 40
patients (63.5%), and 35 of them (87.5%) underwent a primary perforation repair without bowel resection. 73% of surgical
procedures were performed by the general practitioner. Morbidity was 34.9% and mortality was 14.3%. %e average postoperative
hospital stay was 12 days (range: 11–82 days). %ese results were comparable to those observed in the subgroup of patients (17
cases) operated by the general surgeons (morbidity 32.6%, mortality 13.0%, and average postoperative hospital stay 11 days, range:
1–58 days). Conclusion. Acute generalized peritonitis requires urgent management, and it can be effectively carried out, in a
context of limited resources, by a general practitioner with surgical skills
Amputations de membres dans un hopital de zone du Nord-Bènin: A' propos de 122 cas
No full textAbstract
Limb amputation at a zone hospital in Northern Benin area: about 122 cases
Aim: To study limb amputations at the Zone Hospital of Saint Jean de Dieu of Tanguiéta (ZHSJDT) in
Benin.
Materiel and methods: This was a descriptive study with retrospective data collection over a 5 yearperiod
from January 1th 2009 to December 31th 2013. Different registers have been consulted. Data
analysis was conducted by informatics and statistical significance was set at the .05 level.
Results: One hundred and twenty-two (122) amputations in 118 patients were carried out. The mean
age was 37.4 years, ranging from 1 to 80 years and 71.2% of the amputations occurred in manual
workers respect to other professional activities (p = 0.041). Seventy (70) amputations (57.4 %) were
performed on the left body side and 52 (42.6%) on the right side. Lower limbs were involved in 73.8%
of cases and upper extremities in 26.2%. Major amputations accounted for 86.1% and minor amputations for 13.9% (p = 0.002). The causes of amputations were road injuries in 41.0% of cases and
post-traumatic gangrene in 58.0%. Postoperative complications occurred in 37.7% of patients with
22.1% of surgical site infections and 10.2% of psychiatric manifestations. Mortality was 1.7%. Only
9.0% of cases had a prosthetic device after amputations.
Conclusion: The young and active population are the most affected by limb amputations in ZHSJDT.Résumé
Objectif : Etudier les amputations de membres à l’Hôpital de Zone Saint Jean de Dieu de Tanguiéta
(HZSJDT) au Bénin.
Matériel et méthodes : Il s’agissait d’une étude descriptive avec recueil rétrospectif des données sur
une période de 5 ans allant du 1er janvier 2009 au 31 décembre 2013. Différents registres ont été
consultés. Le traitement et l’analyse des données ont été informatiques. Les résultats ont été
considérés significatifs pour un seuil alpha de 5%.
Résultats : Au total, 122 amputations ont été réalisées chez 118 patients. L’âge moyen était de
37.4 ± 21.2 ans avec des extrêmes de 1 et 80 ans et un sex-ratio de 3.7. Les travailleurs manuels ont
représenté 71.2% des amputés (p = 0.041). Soixante-dix amputations (57.4%) ont été réalisées du
côté gauche et 52 (42.6%) du côté droit. Le membre pelvien était concerné dans 73.8% et le membre
thoracique dans 26.2%. Les amputations majeures ont représenté 86.1%, les mineures 13.9% avec
p = 0.002. Les traumatismes ont constitué 41% des causes avec 58% de gangrènes post-traumatiques.
Des complications post-opératoires sont survenues dans 37.7% avec 22.1% d’infection du site opératoire
et 10.2% de manifestations psychiatriques. La mortalité a été de 1.7%. Le taux d’appareillages a
été de 9%.
Conclusion : La population jeune et active est la plus concernée par les amputations de membre à
l’HZSJDT
Aspects bacteriologiques des infections du site operatoire au centre hospitalier departemental du Borgou a Parakou (Benin)
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Objective : Describe the bacteriological aspects of surgical site
infections (SSI) at the regional hospital centre Borgou.Methods : From a descriptive, prospective study from february 2013 to july
2014, about 603 patients operated during the recrutment period(six
mounths), the bacteriological data of 44 cases of SSI diagnosed according to
the criteria CDC/NHSN have been analysed. Results : The frequency of SSI
was 7.3% of the operated (44/603). The superficial incisional infections were
6, the deep infections were 34 and the organ infections or infections of space
were 4. The sampling culture of the liquid was negative with 12 cases
(27.3%) and positive with 32 cases (72.7%). Two germs were isolated in two
cases. The negative Gram germs were the most isolated with 22 cases
(64.7%) of Escherichia coli. The multiresistance was noted with 14 cases out
of 34 (41.2%).
Conclusion : The negative Gram germs were those which predominate in the
infections of the operating site at the regional hospital center Borgou. The
high rate of resistance to usual antibiotics must raise preventive and hard
actions in order to inflect the graph of frequency and protect the antibiotics
Risk factors of surgical site infection at the regional and teaching hospital center of Borgou (Benin)
Get PDFIntroduction: The reduction of the SSI rate requires knowledge of its risk factors. Objective: To analyze the risk factors of SSI occurrence at CHD-B Methods: Prospective, descriptive and analytical study involving 603 patients undergoing general surgery (218) and obstetrics and gynecology (385) from 1stJanuary to 31st July 2013. Results: 44 patients have developed SSI (7.3%). The SSI frequency was 12.8% in general surgery and 4.2% in gynecology-obstetrics (p significant). The mean age of patients developing SSI was 30.7 ± 15.8 years with a minimum and maximum 5 months and 70 years, respectively; and for general surgery patients, there were 23 men and 5 women (p not significant). The presence of preoperative infectious spot at admission (P = 0.003), the preoperative shaving of the site to be incised (p = 0.000), the ASA score (p = 0.000), the surgery contamination class (p = 0.000), and the NNIS score (p = 0.000) were all significantly related to SSI occurrence. Considering all these factors, the NNIS score ≥2 remained the predictive tool by multiplying by 3.4 the risk of SSI occurrence. Conclusion: NNIS score is the best SSI prediction tool at CHD-B
Usefulness of a clinico-biological Francois’ score in the diagnosis of acute appendicitis. Experience of the University Hospital Center of Parakou, Benin
No full textIntroduction: Diagnostic wanderings of acute appendicitis are responsible for serious complications or abusive appendectomies. Existing Clinico-biological scores are efficient. Objective: To determine the diagnostic efficiency of François’ score in acute appendicitis. Methodology: over 10 months, all the patients admitted in the CHUD-Parakou Emergency Department for pain in the right iliac fossa had been examined by resident students who calculated François’ score. After verification by the surgeon, patients were put into three categories: category 1 score ≥ 2; category 2, score between -6 and 2; category 3, score below -6. Sensitivity and specificity were calculated. Results: out of 54 patients selected (29 men and 25 women), 29 were classified as group 1; 19 as group 2 and 6 as group 3. An ultrasound was performed in all patients in group 2, and signs in favor of appendicitis were found in 12 patients. Of the 41 appendicectomies performed, the histologic analysis of 33 operative specimens found a pathological appendix. Sensitivity, specificity and negative predictive value per group were 100%. It has prevented almost in one every four patients (24.07%) an abusive appendectomy. Conclusion: This score would reduce diagnostic wanderings and target patient groups for imaging studies
Surveillance of surgical site infections. An emergency in Saint John of God Regional Hospital of Northem in Republic of Benin
No full textSurveillance of surgical site infections: an emergency in Saint John
of God regional hospital of Northern in Republic of BeninIntroduction: The patient’s endogenous source is mostly involved in
the occurrence of surgical site infections1 (SSI). Exogenous contamination
is less frequent.
Objectives: - Determine the incidence of SSI in Caesarean parturient
- Identify the causative germs.
Methods: This is a prospective cohort study with real-time data collection,
including Caesarean parturients from 01 February to 30 May
2014 and 2015. The follow-up with phone calls was provided up to
+30 days. In case of suspicion of an SSI, samples for cytobacteriological
examination of the liquid coming from the superficial or deep
part of the incision have been realized. The data was entered and
evaluated using Epi info6 software.
Results: The incidence rate in 2014 is 16.72% (52/311) and 4.7% (14/
300) in 2015. Third generation cephalosporins were used in 87.2%
(472/541) for antibiotic prophylaxis. The SSI occurred after the exit of
the parturients in 72.7% of the cases, 42 (63.6%) cases benefited
cytobacteriological analysis from purulent secretions. The examination
returned positive in 43% (18/42) of the cases, 57% (24/42) were
decapitated (sampling after an average delay of antibiotic therapy
of 6.9 ± 2.8 days). 20 germs were isolated, predominantly monomicrobial
(88.9%), 65% were Gram-positive cocci: staphylococcus
aureus accounted for 45% of the isolated germs including MRSA
followed by Streptococcus agalactiae in 20%, no strain of
staphylococcal coagulase has been found. Gram-negative bacilli
represent 35%: 71.4% are enterobacteriaceae, 40% of which are
extended-spectrum beta-lactamase (ESBL), Escherichia coli was
isolated in 10%, the same for pseudomonas aeruginosa (without
any resistance).
Conclusion: The endogenous flora is responsible for the majority of
documented SSI, whether through poor skin preparation or aseptic
error, but the emergence of ESBL is linked to the use of broadspectrum
antibiotics. This requires clinical, microbiological and therapeutic
vigilance in view of their specific resistance profile to antibiotics
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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