Medecine et sante tropicales最新文献

There is currently a hazardous debate between the rational use of antimalarial drugs based on artemisinin derivatives and the antimalarial efficacy of plant extracts of Artemisia spp. This article recall some fundamental rules guiding progresses in malaria treatment and use of artemisinin, with the aim to provide discussion elements to identify the safest place responding to health situations for drugs and phytotherapy.

To review the practice of anesthesia in Conakry hospitals This multicenter descriptive study focused on the practice of anesthesia in Conakry hospitals. We selected 9 healthcare facilities: 6 public and 3 private hospitals. Together, these hospitals had 23 operating theaters, of which 11 (47.8 %) had an anesthesia machine, while 12 (51.9 %) did not have an oxygen supply. Six (26.1 %) had a complete intubation platform. For monitoring, we observed a multiparametric scope in five (21.7 %) of the operating rooms and a pulse oximeter in five. The anesthesia products used most frequently were: ketamine (narcotic), fentanyl (opioid), vecuronium (neuromuscular blocking agent), halothane (volatile anesthetic), and bupivacaine (local anesthetic). These nine facilities have 51 professional anesthesia practitioners: 44 (86.27%) senior technicians in anesthesia-resuscitation, and 7 (13.73 %) physicians specialized in anesthesiology and resuscitation. Over a one-year period (2016), 6303 patients received anesthesia. Gynecology-obstetrical surgery accounted for the highest proportion of patients receiving anesthesia (43.47 %). General anesthesia without intubation was the most common anesthetic technique (67.5 %). Most incidents were intraoperative and cardiovascular (95.6 %). The mortality rate was 0.4 %. Better technical platforms and better training of young practitioners would improve the practice of anesthesia in Guinea.

Posttraumatic diaphragmatic hernias have long been known, but the variety of their clinical expression can lead to diagnostic delay and difficulties in treatment. An intrathoracic hernia of hollow abdominal viscera with subsequent necrosis and perforation is an uncommon late complication with poor prognosis. Surgical treatment is mandatory. Laparotomy is an excellent approach, making it possible to achieve therapeutic objectives for the abdomen and thorax with a short operative time and minimal complications in these patients whose hemodynamic status is often precarious. We report 2 cases of posttraumatic left diaphragmatic hernias with intrathoracic necrosis of the digestive tract, treated by laparotomy.

To determine the influence of therapeutic phlebotomy on the reduction of vaso-occlusive crises (VOCs) and of hospital admissions of patients with sickle cell disease and to describe how they experience this practice. Descriptive cross-sectional study of 27 patients with sickle cell disease who underwent phlebotomies. We estimated the number of VOCs, hemoglobin levels, and patient response. Among 27 sickle cell patients (24 SC and 3 SS) who underwent phlebotomies, there were 22 men (81.5 %) men and 5 (18.5 %) women, with an average age of 34.6 ±10.9 years (range: 21-56 years). Before the phlebotomies, 23 (85.2 %) had showed signs of hyperviscosity, they had a mean of 5.3 ± 1.02 (range: 3-8) VOCs annually, and their mean hemoglobin level was 14.3 ±1.5g/dl (range: 10.4 g/dl-16.8 g/dl). The mean number of phlebotomies was 4.9±4.11 (range: 1-13). After this treatment, 21 (91.3 %) reported that their signs of hyperviscosity disappeared, and the mean number of VOCs annually decreased to 0.9 ±0.07 (range: 0-2). The mean change in hemoglobin was 1.9 ±0.8 g/dl (range: 0.9-3.2 g/dl). Nine patients (6SC and 3SS), 7 under anti-anemic treatment, initially refused phlebotomy, mainly because they did not understand how it could be useful to reduce the amount of blood in patients with a potentially anemic disease. Phlebotomy has resulted in a decrease in the frequency of VOCs and hospitalizations. It is essential to further popularize it and increase patients' aware of its value in combatting sickle cell disease and thus improve their willingness for and adherence to this treatment.

Furuncular myiasis is a cutaneous parasitosis that occurs in tropical regions. It is manifested by lesions with the appearance of pustules, because of the presence of the fly larva in the skin. This misleading appearance can delay diagnosis. The extraction of these Cayor worms can be facilitated by the use of a comedo-extractor.

Silicosis is one of the most prevalent occupational lung diseases and a public health problem throughout the world. Underground miners of copper and cobalt are exposed to the dust of these minerals and thus to the risk of developing silicosis. The objective of this report was to describe a series of silicosis cases in miners exposed to mineral dusts at a mining company operating since the colonial era in Lubumbashi, Katanga province, in the Democratic Republic of the Congo (DRC). This descriptive retrospective study reviewed records at the occupational safety and health department of the mining company mentioned above and included 2500 underground miners who worked there between 1970 and 1995; it collected and analyzed their medical records. Chest radiographs of silicosis patients were classified according to the ILO International Classification of Radiographs of Pneumoconiosis. All miners were males (mean age: 48.5 ±12.5), had low literacy levels, and used no protective device (i.e., mask) against dust. Their mean number of working years in the underground mines was 25.07±7.39 years. Of the 2500 miners, 1.08 % (27/2,500) had developed silicosis. The most common clinical manifestations were dyspnea and cough, and the most prevalent radiologic features large opacities (92.59 %), small opacities (96.27 %), and pleural thickening (25.92 %). The fatality rate was 100 %. This study revealed the absence of safety measures among Congolese underground miners from Lubumbashi, which might have contributed to the development of silicosis in some of them. It is thus necessary to implement occupational safety measures to reduce their risk of silicosis.

Introduction: The causes of short bowel syndrome are multiple, but most often in sub-Saharan Africa they result from extensive surgical resection that leaves less than 200 cm. Intestinal failure appears rapidly with a major hydroelectrolytic deficiency and malabsorption. Management requires parenteral nutrition that can be life-long.

Observation: A 53 year-old patient underwent surgery in 1986 for peptic ulcer disease and recovered successfully. He was admitted in July 2015 for acute bowel obstruction of more than 8 hours duration. Intraoperative exploration showed irreversible ischemia in the small bowel, related to tight adhesions. An extensive resection leaving 110 cm of bowel was carried out. Postoperatively, nutritional monitoring and oral supplementation were prescribed and associated with proton pump inhibitors and antidiarrhea drugs. Parenteral feeding was not available. The postoperative period was characterized by temporary stability followed by a significant weight loss, then by two hospitalizations for severe malnutrition and intercurrent infection. Death occurred 7 months after the operation.

Conclusion: Parenteral nutrition is essential in short bowel syndrome. Availability, especially for a long-term use, is a major problem in our context, and alternatives are rare.

Introduction: free access to antiretroviral (ARV) treatment has made possible the large-scale management of people living with HIV (PLHIV). Nonetheless, some of them abandon treatment and thus become lost to follow-up. Retention is therefore a challenge for treatment programs, especially in resource-limited countries. To improve retention of patients in our active file, we undertook this study, aimed generally at analyzing the follow-up of our patients on ARV. Materials and méthods: This cross-sectional, descriptive, retrospective, and analytical study covered the period from January 2009 to December 2013 at the Treichville sexually transmitted disease (STD) center and reviewed the records of all AIDS patients with ARV treatment aged 16 years and older with complete records. All patients who had not consulted again within 3 months of their last treatment visit were considered lost to follow-up.

Results: This study involved 346 patient records. Their average age was 37.5 years, with a sex ratio of 2.17 in favor of women. The overall dropout rate (percentage of patients lost to follow-up) was 19.94% and peaked at 33.33% in 2011. The average age of the patients lost to follow-up was 35.6 years. Patients who transferred to another care center accounted for 14.16% of all patients, deaths for 4.05%, and 61.56% continued care. Only 1 patient stopped treatment.

Conclusion: The rate of discontinuation of ARV therapy was high in our study. Knowledge of the sociological aspects of those lost to follow-up is necessary to develop strategies for their retention in active treatment.