Prescription of Antibiotics in Oral-Dental Practice: Case of the Dental Practice at the Coyah Prefectoral Hospital in the Republic of Guinea 2019-2020

Introduction: Antibiotics are medications that have the property of destroying bacteria or preventing their proliferation. The aim of this study is to evaluate antibiotic prescriptions in oral practice: case of the dental office of the Coyah prefectural hospital. Methods: This is a descriptive cross-sectional study which took place from August 2019 to January 2020 inclusive, i.e. a duration of six (6) months, during which 400 patients were identified. Results: Our results revealed a frequency of 70% of antibiotic prescriptions. The 16 - 25-year-old age group was the most dismayed, at 47.25% and with an average age of 27.78 years. Men represent 55% compared to 45% of women, i.e. sex ratio of 1.22. Pulp gangrene was the most common pathology in 55% of cases. The most prescribed family was Betalactamine or 61.71% and the most represented molecules were Amoxicillin with 56.10% followed by Metronidazole or 34.16%. And the favorable prognosis was observed in 99% of cases. Conclusion: Prescription should always be based on the benefit-risk ratio. This prescription by practitioners aims to prevent or eradicate infections and pain in order to obtain a good therapeutic result.

Study on the Treatment of Reusable Care Equipment in Public and Private Dental Practices in the City of Conakry

Introduction: The effective sterilization of reusable instruments in dental care is a crucial issue for public health. The aim of this study was to contribute to improving the processing conditions of reusable care instruments in dental practices in the city of Conakry. Methods: We carried out an observational and cross-sectional study of a descriptive type lasting three months from January to April 2022 in public and private dental practices approved for activities. Results: A total of 48 dental practices were surveyed, including 7 public and 41 private. 91.67% had the trays for instrument sterilization. 77.08% had a sterilization device. The instruments were: cleaned 100%, disinfected 70.83%, sterilized 20.83% and 20.83% reused the instruments without being sterilized. 72.97% sterilized the instruments at the end of the day. 50% of respondents declared that there were six stages of sterilization. According to standard standards, one dental office or 2.70% respected the normal sterilization process and 13.51% respected the duration and temperature. The storage quality was inadequate at 95.83%. 95.83% of dental practices are at high risk of contamination. The difficulties encountered by staff in daily activity during our study were lack of hygienists (87.50%), insufficient material resources (58.33%), and lack of protocol procedure (45.83%). Conclusion: This study allowed us to note shortcomings of dental surgeons in the process of processing reusable care materials.

Parkia biglobosa (Jacq.) R. Br. Ex G. Don Fruit Pulp Supplementation in the Diet of Local Chickens in Burkina Faso: Effects on Growth Performance and Carcass Characteristics

This work aimed to evaluate the effects of supplementation of Parkia biglobosa fruit pulp flour in the CPAVI chicken ration on the growth performance and carcass characteristics of local chickens. This study involved 50 local chicks of eight weeks of age. Chickens were divided into 5 groups of 10 chicks corresponding to five experimental rations containing 0%, 1%, 2%, 3% and 4% pulp from fruits of P. biglobosa. The nutritional composition of P. biglobosa fruit pulps were analyzed, then growth parameters and carcass characteristics were measured. The results showed that the fruit pulps of P. biglobosa were rich in metabolizable energy (4015.02 ± 0.21 Kcal/kg), crude fiber (16.88% ADF and 19.81% NDF) and potassium (2.45% ± 0.01%). Thus, the group of local chickens fed the diet containing 1% supplementation had a significantly higher live weight (1200.85 g) and carcass yield (91.99 g) (P supplementation. Additionally, individual feed consumption and average daily gain of the group at 1% supplementation were higher. In short, the flour from the pulp of the fruit of Parkia biglobosa can be supplemented up to 1% in the CPAVI pullet type feed for local chickens.

Prevention of Venous Thromboembolism in General Surgery at Gabriel TouréUniversity Hospital in Mali

Through its impact on morbidity and mortality and the cost of medical care, Venous Thromboembolism (VTE) has a significant influence on the quality of care in a surgical environment. The objectives were to determine the risk of postoperative venous thromboembolism and to assess its prophylactic management in the general surgery department of Gabriel Toure University Hospital. This was a prospective observational study from May 01, 2018 to December 31, 2018. It included all patients of 18 years old and over, operated in regulated surgery, under general anesthesia in the department. For all of these patients, Caprini score was used to assess the risk of VTE. The ninth American College of Chest Physicians’ Consensus was used as guidelines to assess Thromboprophylaxis practices in the ward. The Caprini score was evaluated in 80 patients for 8 months. The average age was 50.2 years. The sex ratio was 0.48. The risk level of VTE was low in three patients (3.8%), moderate in 13 patients (16.3%), high in 34 patients (42.5%) and highest in 30 patients (37.5%). The main risk factors found were major surgery (87.5%), age > 40 years (72.5%), cancer (33.8%), bed rest (31.2%), obesity (27.5%) and minor surgery (12.5%). Early mobilization was performed in all patients. Pharmacologic prophylaxis was required in 80% of our patients but only 38.8% had received low molecular weight heparin. VTE complicated 5 procedures, including 3 cases of deep vein thrombosis of the limbs and 2 cases of pulmonary embolism who died. Venous thromboembolism is serious and common in surgical settings. Its prevention remains insufficient in our context.

Appendicular Abscess in General Surgery at the Bocar Sidi Sall University Hospital in Kati

Introduction: Appendicular abscess is a progressive complication of acute appendicitis in which the spread of infection is contained by the greater omentum and the slender loops resulting in the formation of a true septate abscess of the large peritoneal cavity. Materials and Methods: This was a retrospective study from January 2010 to December 2019 carried out at the Bocar Sidi Sall University Hospital in Kati (CHU BSS in Kati) in general surgery. It concerned all patients operated on for appendicular abscess in the department. Results: 75 cases of appendicular abscess were collected, which represented 5.76% of surgical emergencies and 25% of acute appendicitis. The average age of the patients was 29 years. The male sex represented 67% of our patients with a sex ratio of 2. The average consultation time was 5 days. Abdominal pain was noted in all patients. It was localized in the right iliac fossa in 80% (n = 60) and diffuse in 2.7% of cases (n = 2). It was accompanied by nausea and vomiting in 93% of cases (n = 70), urinary disorders in 20% (n = 15), fever in 94% (n = 71), cessation of materials and gas in 1.33% (n = 1). Abdominal ultrasound was performed in 86% (n = 65). It made it possible to suggest a peri-appendicular effusion. Biological examination revealed a neutrophilic hyperleukocytosis greater than 20,000/mm3 in 47 patients, or 63%. All the patients were operated on by laparotomy (Marc Burney or midline subumbilical) under general anesthesia. The length of hospitalization was 6 days. We have not recorded any deaths. Morbidity was 8% (n = 6) represented by parietal suppuration. The postoperative course was straightforward in 92% of cases (n = 69). Conclusion: Appendicular abscess is a frequent medico-surgical emergency, the prognosis of which depends greatly on early diagnosis and adequate and immediate management.

Rare Case of Acute Peritonitis by Perforation of an Appendicular Schistosomiasis at the CHU BSS in Kati

Perforation of a pseudo appendicular tumor of bilharzial origin (bilharzia) is a rare etiology of acute peritonitis. His diagnosis is histopathological. The existence of comorbid malaria and surgical pathology is frequent in having a positive thick drop with Schistosoma mansoni eggs in his stool. After 3 months, the patient is doing well. In conclusion, we recommend the histopathological analysis of the surgical specimen after appendectomy and the detection of haematozoa for malaria in any case of fever in a surgical environment.

Male Breast Cancer: Diagnostic and Prognostic Features in Mali

Introduction: Male breast cancer is rare;representing 1% of breast cancers and less than 1% of all male neoplasia worldwide. We here analyzed the clinical, histological, therapeutic and prognostic characteristics of male breast cancer in Bamako, Mali. Patients and methods: A retrospective descriptive study was conducted on 14 male patients with breast cancer who visited two university hospitals in Bamako (Hospital Gabriel TOURE and Hospital du Point G) in Mali, from January 2005 to December 2018. Results: Male breast cancer represented 0.63% of all breast cancers and 0.23% of all male cancers. The following was observed: the mean age of 53 years (range: 23 - 82);a family history of cancer in 2;breast pain in 9;the average time to consultation of 8 years (6 - 24);gynecomastia found in 1;the tumor palpable in all 14 (size of 5 cm [3 - 10]);ulceration in 5. The most common histological type was non-specific infiltrating carcinoma with 92.8%. SBR II grade was found in 78.5% of cases. Of 8 patients with immunohistochemistry, hormone receptor positive was in 13 and Her2 positive was in 5. Metastases were found in 4, 2 pulmonary and 2 hepatic. Treatment: Neoadjuvant chemotherapy in 21.4%;radical surgery in 13 cases;surgery + radiotherapy in 2;surgery + hormonal therapy in 4. After an average follow-up of 36 months, 1 patient developed a lung metastasis and another patient had a lymph node recurrence. Conclusion: Male breast cancer was detected at relatively later stages. Physicians must be aware of this condition.

Giant Lactant Adenoma: About a Case

Affecting young women, lactating adenoma is a rare benign tumor of the breast. It is seen mainly in the third trimester of pregnancy and in the postpartum period. Clinically, it is a solid mass, mobile typically benign but its character of rapid evolution is reminiscent of phyllodes tumors, sarcomas and galactoceles. The definitive diagnosis is histological. We report a case of lactating adenoma in a 26-year-old lactating woman, third procedure, second pare, with a history of tumor resection of the outer quadrants of the left breast, 9 months ago, whose histology evoked a fibrotic disease, cystic breast associating non-specific subacute mastitis with suppuration. Received for recurrence of a tumor in the left breast which was the site of a polylobed mass of about 10/5 cm occupying 3/4 of the breast with mobile ipsilateral axillary adenopathies. A micro tru-cut biopsy was performed and the histology was in favor of a lactating breast adenoma with no signs of malignancy. She underwent surgical excision, the consequences of which were simple.

Double Volvulus, Transverse Colon and Sigmoid at Kati Chu BSS: About 2 Cases

The simultaneous double volvulus of the transverse colon and sigmoid in the same patient is a rare cause of intestinal occlusion. Two cases were observed in general surgery in Kati. Its clinical symptomatology does not differ from other occlusions as well as simple radiological images. It is an extreme surgical emergency, the diagnosis is generally intraoperative. Extensive left hemi colectomy with terminoterminal rectal anastomosis was performed. The surgical follow-up was simple.

Traumatic Diaphragmatic Injury at Gabriel Toure University Hospital, Mali

Traumatic diaphragmatic injury (TDI) is rare and is most often the result of a traffic road accident (TRA) or an assault. We initiated this study with the aims of determining the epidemiological, clinical and therapeutic aspects of TDI at Gabriel Toure University Hospital. This was a retrospective study from January 1999 to June 2021 that included all patients who presented a diaphragmatic injury consecutive to abdominal and/or thoracic trauma. In 22 years and 6 months, 46 cases of TDI were collected. They represented 0.17% of hospitalizations, 0.26% of surgical emergencies and 5.5% of thoraco-abdominal traumas. The average age was 31.69 years with a sex ratio of 3.2. Criminal stabbings accounted for 56.5% and TRA for 19.6%. Penetrating injuries accounted for 78.3% of cases. The parietal lesion was thoracic in 21 cases (45.7%), abdominal in 19 cases (41.3%) and thoraco-abdominal in 6 cases (13%). The chest X-ray, performed in 15 patients, showed an intrathoracic gas bubble (4 cases) and hemothorax (6 cases). Diagnosis of diaphragmatic lesion was preoperative in 21.7% (10 cases). The diaphragmatic breach was on the left side in 65.2% (30 cases) and the average size was 3.17 cm. Laparotomy was performed in 89.1%, thoracotomy in 4.4% and thoraco-laparotomy in 6.5% of cases. The surgical procedure consisted of reduction of the herniated viscera in 15.2% (7 cases) and closure of the diaphragmatic breach with non-absorbable sutures in 82.6% (36 cases). Chest tube drainage was performed in 73.9%. The average length of hospital stay was 9.8 days. Mortality was 13.04%. Conclusion: Traumatic diaphragmatic injury is rare but its frequency is increasing in our country. It most often affects the young man victim of assault or TRA. This type of trauma is rarely isolated;you have to think about it in case of any thoraco-abdominal trauma. The treatment is surgical. The prognosis depends on the severity of the associated lesions.

Fascist Leg Necrosis at the Bocar Sidi Sall University Hospital (BSS) in Kati (Mali)

Necrotizing fasciitis is a bacterial dermo-hypodermitis of necrotizing type with involvement of the superficial fascia of the muscles. We report the case of a 50-year-old patient with necrotizing fasciitis of the left leg following erysipelas. Clinical Case: A 50-year-old patient, received at the emergency department for necrotizing wound of the left leg, evolving for 25 days. The examination of the patient made it possible to find: an alteration of the general condition with a WHO score classified stage II. A necrotizing wound of the lower 2/3 of the left leg and the dorsal side of the left foot allowing pus to flow in places, the pedious pulse was well perceived, lymphadenopathy at the root of the homolateral thigh. The complete blood count made it possible to objectify a predominantly neutrophil hyperleukocytosis greater than 10,000/mm3. We first carried out a complete debridement of the necrotic tissues, in a second time we took the patient back to do the autocutaneous graft. The surgical follow-up was simple. Conclusion: Necrotizing fasciitis is a serious infection, management is multidisciplinary.

Kati Chu BSS External Genital Organ Delivery Syndrome: Inguinal Pedicle Flap Plasty

Fournier’s syndrome is a poly microbial necrotizing fasciitis, of severe evolution of the perineum and external genitals. Objectives: We report the experience of the service in the management of Fournier gangrene of the external genital organs by inguinal flap pediculated in front of the loss of significant substances of the scrotum. Patients and method: This was a mono-centric retrospective study from January 2008 to August 2021 in the General Surgery Department of the Bocar Sidi Sall University Hospital (CHU BSS) in Kati. It focused on patients treated for Fournier gangrene of external genitals. The variables studied were age, sex, blood count, germs encountered, the antibiogram, duration of evolution, reconstruction of the scrotum by pedicle flap, and morbidity. Results: During the study period we collected 5 cases of Fournier gangrene of external genitals in the service. The average age was 57.6 years and all the patients were male. The average duration of evolution was 5 days for an average age of 57.6 years. All patients were male. Echerichia coli (E. coli) was the frequently observed germ followed by Enterobacter fécalis (E. fecalis). They were resistant to the usual antibiotics. The germs were 100% sensitive to imipeneme and nitrofurantoin, 70% to gentamycin. The wide necrosectomy followed 3 weeks later by the inguinal flap pedicular plasty greatly improved the surgical procedures. Conclusion: Fournier’s syndrome is a medical surgical emergency whose prognosis is strongly related to early management.

TyphicIleal Perforation at Kati Chu-BSS for Diagnostic and Therapeutic Aspects (Mali)

Ileal perforation of typhus origin is a common and serious complication of typhoid fever in tropical environments. It is one of the main causes of morbidity in surgery in Mali. However, it would be preventable if salmonellosis were properly managed upstream, and if our living environments were cleaned up. The purpose of this study is to report on the experience of the Kati UHC General Surgery Department in the management of peritonitis by typhic perforation and to assess its prognosis. Patients and Method: This is a retrospective descriptive study that took place from January 2007 to December 2020 in the General Surgery department of the Hospitalo-University BSS Center of Kati (Mali). We have included patients who have undergone peritonitis with confirmed typhic ileal perforation with laparotomy. The other etiologies of peritonitis by ileal perforation were not retained. Results: In 14 years, we collected 89 cases of peritonitis by typhic ileal perforation. It accounted for 3.14% (89/2829) of surgical procedures, 37.5% (89/1181) of visceral surgical emergencies and 27.6% (89/322) of all acute peritonitis causes combined. There were 70 men against 29 women;the sex ratio was 2.4 with an average age of 25.8 years (extremes 8 years to 65 years). Anastomosis resetions (ileo ileal and ileocolic) predominated in 71.8% of patients. However, the ileo stoma was performed in 5.6%. A significant relationship (p 0.05) was observed between high mortality and MPI score > 26. Morbidity was 39.4% with mortality of 15.7%. The average length of stay in hospital was 12.2 days. Conclusion: Typhoid ileal perforation is common in young male adolescents in visceral surgery. This pathology generates significant morbidity. However with the extension of hand washing after Ebola disease its frequency has dropped.

Traumatic Perforation of the Small Intestine in General Surgery of the CHU Gabriel Touré

Goal: To determine hospital frequency, to describe the clinical and therapeutic aspects and to determine the prognosis. Patients and Methods: This was a retrospective and prospective study carried out in the General Surgery Department from 1 January 1999 to 31 December 2015. Inclusion criteria: 1) open or closed trauma of the abdomen with perforation of the small bowel;2) clinical examination (abdominal pain, vomiting, fever, abdominal contracture, evisceration, intraoperative findings);3) paraclinical examinations: pneumoperitoneum on the abdominal X-ray without preparation (ASP) and CT scan. Exclusion Criteria: Abdominal trauma without perforation of the small bowel. We selected 128 patients operated for traumatic perforation of the small bowel. The data was entered and analyzed using Word, Excel 2007 and Statistical Package and Social Science Windows 16.0. The statistical analysis consisted in the calculation of the different frequencies of the variables studied. We used the Khi2 test with significance level P Results: We recorded 119 men versus 9 women and the sex ratio was 13.22. The mean age was 25 years with extremes varying between 15 and 70 years. The majority of patients 57.7% (74 cases) came from the capital, 46.1% (59 cases) were workers, 26.6% (34 cases) of the students. The average time to admission was 29 hours. The main etiologies were road traffic accidents 36.7% (47 cases), stabbing 21.9% (28 cases), firearm 14.8% (19 cases), and sports accidents 10.1% (13 cases). The main clinical signs were abdominal pain 48.44% (62 cases), abdominal contracture 60% (76 cases), disappearance of pre-liver dullness 66.36% (84 cases), and Douglas painful 74.4% (94 cases). The abdominal X-ray without preparation (A.S.P) allowed to objectify a pneumoperitoneum in 45.31% and the scanner a liquid effusion in 45.31% with the associated lesions in 37.5% (48 cases). The surgical treatment consisted of 60.15% suture excision (77 cases), 25% anastomosis resection (32 cases) and a 15% stoma (19 cases). The average length of hospital stay was 9 days with extremes of 1 to 60 days. The morbidity was 10.15% at the site of surgical site (OS) infection 17.4% (8 cases), postoperative peritonitis 3.1% (4 cases) and evisceration 0.8% (1 case). Mortality was 17.18% due to septic shock and multivisceral failure. Conclusion: Traumatic perforation of the small bowel is an emergency. Young people are more victims. The prognosis depends on the speed of diagnosis and management. Emphasis should be placed on prevention.

Post-Operative Peritonitis: Diagnostic Problems, Morbidity and Mortality in Developing Countries

Goal: To study the diagnostic difficulties and post-operative morbidity and mortality of peritonitis. Patients and Methods: Retrospective study about the records of adult patients operated on between 1999 and 2013 whose diagnosis of post-operative peritonitis was made. Results: We achieved 23,573 lanterns and recorded 148 cases of postoperative peritonitis or 0.62%. The medium age was 37.1 ± 17.7 years and the sex ratio was 1.2. The delay between the initial intervention and reoperation was less than 5 days. Factors occurrence of postoperative peritonitis were those related to the initial surgery: septic context 70.8%, emergency surgery 81.1% under the seat mesocolic 25% and 20.3% initial surgical technique. The diagnosis was made preoperatively in 62.2% (n = 92). Ultrasound has found an effusion in 29.7% (n = 44). Cytobactériologic review identified germs in 85.1% (n = 126) and sterile in 12.9% of patients (n = 22). The most frequent etiologies were: 22.9% anastigmatic leak (n = 34), the phoenix abscess in 17.6% (n = 26), iatrogenic perforation 13.5% (n = 20) and digestive fistula 25% (n = 37). Other causes were the stoical necrosis 12.2% (n = 18) and evisceration 8.8% (n = 13). We performed a digestive stoma in 61% (n = 89), a closure of the abdomen bolsters in 8.8% (n = 13), a suture in iatrogenic perforation in 13.5% (n = 20) and washing with drainage in patients with phoenix abscess in 17.6% (n = 26). Morbidity was 22.3% and 53.4% mortality. Conclusion: The diagnosis of post-operative peritonitis is difficult in a developing country. Morbidity and mortality is high. Improved diagnostic tools are needed.

Antibioprophylaxy by the Surgery Staff in the Teaching Hospital Gabriel Touréin Mali

This prospective survey was conducted from February to December 2014 about the use ceftriaxone (ceftriaz) for antibioprophylaxy concerning 300 patients by the surgery staff in the Gabriel Touré Teaching Hospital in Mali. The quantity of drug used was based on the weight of the patient. One dose was administrated in intravenous at the anesthesiology induction time. For more than 2 hours of intervention time, 4 (1.3%) patients received a second dose. The majority of cases (189, 63%) were out of emergency (emergency cases—111, 37%). The mean age was 41.6 years (range: 3 - 95 years). The patients were classed Altmeir II 203 (67.7%) and Altmeir I 97 (32.3%). The NNISS score 0 concerned 101 (33.6%) and NNISS 1 in 180 (60%) patients. The factors of risky were anemia (38;12.7%), diabetes (6;2%), and HIV (3;1%). The mean of intervention duration was 56.8?±?27.5 minutes. Four cases of intervention site infection were encountered caused by?Pseudomonas?aeruginosa?in 2 patients;?Escherichia coli?(1 case), and?Staphylococcus aureus?(1 case). Conclusion: Antibioprohylaxy is not the only way to prevent infections but it stays necessary. The respect of hygien and aseptic measures should be used to reduce the rate of intervention site infection.

Operating Site Infections at General Surgery Department of Gabriel Toure Training Hospital

The operating site infections constitute the major postoperative issue in surgery. Our objectives were to determine the hospital frequency, the risk factors, the involved germs as well as the cost generated by the operating site infections. Method: Our three months prospective survey run from September the 1st to November the 30th 2013 has included all department patients being operated on and hospitalized. The criteria have been set by CDC d’Atlanta. Results: 374 files were involved, among them 229 (61.2%) were emergencies and 145 (38.8%) were scheduled. The average age was 41 (extremes 7 and 95 standard deviation 17.46), the sex ratio 1.67. The infective risk according to Altmeier has found 17.5% type 1, 25.1% type 2, 11.2% type 3 and 46.3% type 4;according to NNISS, 96 (25.7) were NNISS 0;94 (51.9%) NNISS 1;80 (21.4%) NNISS 2;and 4 (1.1%) NNISS. In the Altmeier class I have not got antibiotic before infection signs appearances. Our overall rate of operating site infections was 7.9% (29 cases), with 24 (82.8%) emergency cases. According to Altmeier’s class of infective risk, the rate of operating site infections was 1.54% making 1 out of 65 type I patients;4.3% making 4 out of 93 type II patients;11.9% making 5 out of 42 type III patients;10.9% making 19 out of 174 type IV patients. According to NNISS, the infective risk has been assessed and was 2.08% for score 0, we have got 8.25% score 1, and 12.5% for score 2, and 25% for score 3. The bacteriology has been dominated by Escherichia colii(51.7), Proteus mirabilisi(13.8), and Klebsiella pneumoniaei(10.34). The germs have been resistant to the combination Amoxicillin-clavulanic Acid between 50% and 87% of cases. The most active antibiotics on the germs have been Cephalosporin, Polypeptides, and aminoglycosides. The hospital stay has been delayed to 12 days on average by operating site infections, making 2.5 times greater than those uninfected. The infection has increased the cost of management around 600 Euro.

Toward an Intelligent System for Taurine Cattle Recognition

Unlike zebus, taurine cattle have the natural ability to resist trypanosomosis, a parasitic disease endemic to the humid areas of West Africa. However, repeated crossbreeding between zebus and taurine cattle is jeopardizing the genetic heritage of the Taurines and their ability to resist trypanosomosis. To strengthen protection and conservation efforts, it is essential to accurately distinguish purebred taurines from crossbreds. In this study, five Machine Learning models were built using morphological data collected from 1968 cattle. These models were trained to determine whether a given individual is purebred taurine or not. The classifiers yielded promising results. The random forest model and RBF Kernel SVM performed the best with up to 86% and 85% accuracy respectively. Moreover, the study of the correlation coefficients and the feature importance scores allowed us to define the most discriminating morphological traits.