Since its outbreak in December 2019 in Wuhan Province (China), the Coronavirus (COVID-19) disease quickly spread around the world in such a way that most response plans were outdated. There was an urgent need to chang...Since its outbreak in December 2019 in Wuhan Province (China), the Coronavirus (COVID-19) disease quickly spread around the world in such a way that most response plans were outdated. There was an urgent need to change and adapt response strategies as the virus globally spread. Entire firms and economies were brought to a standstill in order to reduce the virus’ capacity to spread and to limit some of the short-term impacts in order to save time and find out solutions to come back to a more or less normal way of life. Thus, most of the countries that closed their air, sea and land borders had to reopen them progressively, with travel restrictions submitted to rigid controls. In Côte d’Ivoire, as in all other countries, air travellers leaving the territory were required to provide a certificate for a negative COVID-19 test, valid for 24 to 72 hours depending on the country of destination. However, the national system implemented could not provide a result before 48 hours. The objective of this work was to develop an alternative strategy to the system for air travellers who were in a hurry and those who had a computer bug in obtaining their result. A total of 38,444 air travellers benefited from this strategy implemented by the Institut Pasteur de Côte d’Ivoire during these two years.展开更多
Background: Multi-scar uterus is a uterus with two or more scars due to surgery or trauma. Objective: The aim was to compare the maternal and fetal prognosis of emergency C-sections of bi-scar uteruses to those of ute...Background: Multi-scar uterus is a uterus with two or more scars due to surgery or trauma. Objective: The aim was to compare the maternal and fetal prognosis of emergency C-sections of bi-scar uteruses to those of uteruses with at least 3 scars at the Nianankoro Fomba Hospital in Segou. Materials and Methods: It was a descriptive and analytical cross-sectional study with prospective data collection over a 24-month period from March 20, 2018, to March 20, 2020. Results: In 2 years, we collected 103 emergency C-sections for multi-scar uterus out of 1198 C-sections with a frequency of 8.6%. The age group of 20 to 35 years was the most represented with 86.4%. The bi-scar uteruses were the most frequent with 77.7%. In 71.8% of cases, the C-section was performed during the latent phase of labor. The C-section was performed under loco-regional anesthesia in 89.3% of cases. Difficulties in hemostasis and bladder injury were the most frequent intraoperative accidents. Surgical site infection was the main postoperative complication. No maternal deaths were recorded. The perinatal prognosis was marked by 4.3% fresh stillbirths in bi-scar uterus against 3.7% in three or more scar uteruses and including 2 fresh stillbirths and 1 macerated. We did not record any early neonatal deaths after C-section. Conclusion: The frequency of emergency C-sections in patients with a multi-scar uterus remains very high in our hospital. A better awareness of the patients, their spouses and all the actors involved in the management of pregnancies and childbirth, can contribute to curb this trend.展开更多
BACKGROUND Hepatitis C virus(HCV)infection is a leading cause of chronic liver disease worldwide.New treatments for HCV revolutionized management and prompted the world health organization to set the goal of viral eli...BACKGROUND Hepatitis C virus(HCV)infection is a leading cause of chronic liver disease worldwide.New treatments for HCV revolutionized management and prompted the world health organization to set the goal of viral elimination by 2030.These developments strengthen the need for HCV screening in order to identify asymptomatic carriers prior to development of chronic liver disease and its complications.Different screening strategies have been attempted,most targeting high-risk populations.Previous studies focusing on patients arriving at emergency departments showed a higher prevalence of HCV compared to the general population.AIM To identify previously undiagnosed HCV carriers among high risk emergency room attendees and link them to care for anti-viral treatment.METHODS In this single center prospective study,persons visiting the emergency department in an urban hospital were screened by a risk factor-specific questionnaire.The risk factors screened for were exposure to blood products or organ transplantation before 1992;origins from countries with high prevalence of HCV;intravenous drug use;human immunodeficiency virus carriers;men who have sex with men;those born to HCV-infected mothers;prior prison time;and chronic kidney disease.Those with at least one risk factor were tested for HCV by serum for HCV antibodies,a novel oral test from saliva(OraQuick®)or both.RESULTS Five hundred and forty-one participants had at least one risk factor and were tested for HCV.Eighty four percent of all study participants had only one risk factor.Eighty five percent of participants underwent OraQuick®testing,34%were tested for serum anti-HCV antibodies,and 25%had both tests.3.1%of patients(17/541)had a positive result,compared to local population incidence of 1.96%.Of these,82%were people who inject drugs(current or former),and 64%served time in prison.One patient had a negative HCV-RNA,and two patients died from non-HCV related reasons.On review of past medical records,12 patients were found to have been previously diagnosed with HCV but were unaware of their carrier state.At 1-year follow-up none of the remaining 14 patients had completed HCV-RNA testing,visited a hepatology clinic or received anti-viral treatment.CONCLUSION Targeted high-risk screening in the emergency department identified undiagnosed and untreated HCV carriers,but did not improve treatment rates.Other strategies need to be developed to improve linkage to care in high risk populations.展开更多
Introduction: Knowledge, skill and training in addition to quick thinking, come to the rescue of Anesthesiologists when encountering an unanticipated difficult airway during emergency Caesarean section. Ability to rea...Introduction: Knowledge, skill and training in addition to quick thinking, come to the rescue of Anesthesiologists when encountering an unanticipated difficult airway during emergency Caesarean section. Ability to react with time to spare will ensure maternal and fetal well being while handling this life threatening emergency. Case History: While anesthetizing a 22-year parturient for emergency Caesarean section, the endotracheal tube was inadvertently placed in the esophagus. As the “call for help” was activated, the esophageal tube was delivered thru the endoscopic port of a Patil-Syracuse face mask. After confirming our ability to ventilate the patient without distending the stomach while maintaining the oxygen saturation and end tidal carbon dioxide levels within normal limits, surgery was allowed to proceed under mask anesthesia employing oxygen, nitrous oxide and sevoflurane with rocuronium for muscle relaxation. After a healthy infant was delivered, definitive airway access was obtained with Glidescope? assisted fiberoptic intubation. The esophageal tube was then removed. Further surgery proceeded uneventfully. Discussion: By choosing to deliver the proximal end of the inadvertently placed esophageal tube thru the endoscopic port of a Patil-Syracuse mask and mask ventilating the patient, we have been able to provide that few precious minutes of oxygenation to the distressed fetus before delivery. By isolating and venting the stomach thru the esophageal tube we provided maternal air way protection during the initial phase of the delivery. Definitive airway access was obtained as soon as additional help and equipment were available. Conclusion: Difficult airway algorithm while comprehensive, does not address the question of time management. While dealing with a difficult airway in obstetric anesthesia, time is the single most important factor, which will determine the maternal and fetal well being. We in our case report have attempted to answer that question of “time”.展开更多
Due to France has suffered from many terrorist attacks and the number of visitors to the Louvre has gradually increased in recent years, a good evacuation plan for the Louvre is of vital significance. We use the minim...Due to France has suffered from many terrorist attacks and the number of visitors to the Louvre has gradually increased in recent years, a good evacuation plan for the Louvre is of vital significance. We use the minimization of the total evacuation time of all tourists as the optimization goal to find an optimal path. For conventional emergencies, a static model is built to evacuate visitors. And then we establish a nonlinear programming model. Using Lingo software, we get the distribution information of the visitors in different exhibition halls. For unconventional emergencies, we establish an adaptive dynamic model of tourist evacuation based on genetic algorithm. The sensitivity analysis of the model is considered by adding new paths. By solving the nonlinear programming problem with the double objective function of maximizing evacuation time and balancing the number of people in every path, we get the evacuation time last 1582.74 s. Finally, according to our result, we built mathematical models for the evacuation after an emergency and analyzed how to adapt and implement our models for other large and crowded structures.展开更多
Emergency C-sections are performed for various reasons. This is a case report of emergency C-section performed due to fetal distress. This is a classic case report which emphasizes the importance of managing emergency...Emergency C-sections are performed for various reasons. This is a case report of emergency C-section performed due to fetal distress. This is a classic case report which emphasizes the importance of managing emergency C-sections according to international standards and acknowledges co-operation of obstetrician and anesthesiologist. We reviewed literature about emergency C-sections and discussed sensitive time intervals, types of anesthesia and neonatal resuscitation.展开更多
AIM To investigate the role of bloodtransfusion in TT viral infection(TTV).METHODS We retrospectively studied serumsamples from 192 transfusion recipients whounderwent cardiovascular surgery and bloodtransfusion betwe...AIM To investigate the role of bloodtransfusion in TT viral infection(TTV).METHODS We retrospectively studied serumsamples from 192 transfusion recipients whounderwent cardiovascular surgery and bloodtransfusion between July 1991 and June 1992.Allpatients had a follow-up every other week for atleast 6 months after transfusion.Eightyrecipients received blood before screeningdonors for hepatitis C antibody(anti-HCV),and112 recipients received screened blood.Recipients with alanine aminotransferase level】2.5 times the upper normal limit were testedfor serological markers for viral hepatitis A,B,C,G,Epstein-Barr virus and cytomegalovirus.TTV infection was defined by the positivity forserum TTV DNA using the polymerase chainreaction method.RESULTS Eleven and three patients,whoreceived anti-HCV unscreened and screened'blood,respectively,had serum ALT levels】90 IU/L.Five patients(HCV and TTV:1;HCV,HGV,and TTV:1;TTV:2;and CMV and TTV:1)were positive for TTV DNA,and four of them hadsero-conversion of TTV DNA.CONCLUSION TTV can be transmitted viablood transfusion.Two recipients infected byTTV alone may be associated with the hepatitis.However,whether TTV was the causal agentremains unsettled,and further studies arenecessary to define the role of TTV infection inchronic hepatitis.展开更多
文摘Since its outbreak in December 2019 in Wuhan Province (China), the Coronavirus (COVID-19) disease quickly spread around the world in such a way that most response plans were outdated. There was an urgent need to change and adapt response strategies as the virus globally spread. Entire firms and economies were brought to a standstill in order to reduce the virus’ capacity to spread and to limit some of the short-term impacts in order to save time and find out solutions to come back to a more or less normal way of life. Thus, most of the countries that closed their air, sea and land borders had to reopen them progressively, with travel restrictions submitted to rigid controls. In Côte d’Ivoire, as in all other countries, air travellers leaving the territory were required to provide a certificate for a negative COVID-19 test, valid for 24 to 72 hours depending on the country of destination. However, the national system implemented could not provide a result before 48 hours. The objective of this work was to develop an alternative strategy to the system for air travellers who were in a hurry and those who had a computer bug in obtaining their result. A total of 38,444 air travellers benefited from this strategy implemented by the Institut Pasteur de Côte d’Ivoire during these two years.
文摘Background: Multi-scar uterus is a uterus with two or more scars due to surgery or trauma. Objective: The aim was to compare the maternal and fetal prognosis of emergency C-sections of bi-scar uteruses to those of uteruses with at least 3 scars at the Nianankoro Fomba Hospital in Segou. Materials and Methods: It was a descriptive and analytical cross-sectional study with prospective data collection over a 24-month period from March 20, 2018, to March 20, 2020. Results: In 2 years, we collected 103 emergency C-sections for multi-scar uterus out of 1198 C-sections with a frequency of 8.6%. The age group of 20 to 35 years was the most represented with 86.4%. The bi-scar uteruses were the most frequent with 77.7%. In 71.8% of cases, the C-section was performed during the latent phase of labor. The C-section was performed under loco-regional anesthesia in 89.3% of cases. Difficulties in hemostasis and bladder injury were the most frequent intraoperative accidents. Surgical site infection was the main postoperative complication. No maternal deaths were recorded. The perinatal prognosis was marked by 4.3% fresh stillbirths in bi-scar uterus against 3.7% in three or more scar uteruses and including 2 fresh stillbirths and 1 macerated. We did not record any early neonatal deaths after C-section. Conclusion: The frequency of emergency C-sections in patients with a multi-scar uterus remains very high in our hospital. A better awareness of the patients, their spouses and all the actors involved in the management of pregnancies and childbirth, can contribute to curb this trend.
基金Supported by an Educational Grant from AbbVie Inc.Israel.
文摘BACKGROUND Hepatitis C virus(HCV)infection is a leading cause of chronic liver disease worldwide.New treatments for HCV revolutionized management and prompted the world health organization to set the goal of viral elimination by 2030.These developments strengthen the need for HCV screening in order to identify asymptomatic carriers prior to development of chronic liver disease and its complications.Different screening strategies have been attempted,most targeting high-risk populations.Previous studies focusing on patients arriving at emergency departments showed a higher prevalence of HCV compared to the general population.AIM To identify previously undiagnosed HCV carriers among high risk emergency room attendees and link them to care for anti-viral treatment.METHODS In this single center prospective study,persons visiting the emergency department in an urban hospital were screened by a risk factor-specific questionnaire.The risk factors screened for were exposure to blood products or organ transplantation before 1992;origins from countries with high prevalence of HCV;intravenous drug use;human immunodeficiency virus carriers;men who have sex with men;those born to HCV-infected mothers;prior prison time;and chronic kidney disease.Those with at least one risk factor were tested for HCV by serum for HCV antibodies,a novel oral test from saliva(OraQuick®)or both.RESULTS Five hundred and forty-one participants had at least one risk factor and were tested for HCV.Eighty four percent of all study participants had only one risk factor.Eighty five percent of participants underwent OraQuick®testing,34%were tested for serum anti-HCV antibodies,and 25%had both tests.3.1%of patients(17/541)had a positive result,compared to local population incidence of 1.96%.Of these,82%were people who inject drugs(current or former),and 64%served time in prison.One patient had a negative HCV-RNA,and two patients died from non-HCV related reasons.On review of past medical records,12 patients were found to have been previously diagnosed with HCV but were unaware of their carrier state.At 1-year follow-up none of the remaining 14 patients had completed HCV-RNA testing,visited a hepatology clinic or received anti-viral treatment.CONCLUSION Targeted high-risk screening in the emergency department identified undiagnosed and untreated HCV carriers,but did not improve treatment rates.Other strategies need to be developed to improve linkage to care in high risk populations.
文摘Introduction: Knowledge, skill and training in addition to quick thinking, come to the rescue of Anesthesiologists when encountering an unanticipated difficult airway during emergency Caesarean section. Ability to react with time to spare will ensure maternal and fetal well being while handling this life threatening emergency. Case History: While anesthetizing a 22-year parturient for emergency Caesarean section, the endotracheal tube was inadvertently placed in the esophagus. As the “call for help” was activated, the esophageal tube was delivered thru the endoscopic port of a Patil-Syracuse face mask. After confirming our ability to ventilate the patient without distending the stomach while maintaining the oxygen saturation and end tidal carbon dioxide levels within normal limits, surgery was allowed to proceed under mask anesthesia employing oxygen, nitrous oxide and sevoflurane with rocuronium for muscle relaxation. After a healthy infant was delivered, definitive airway access was obtained with Glidescope? assisted fiberoptic intubation. The esophageal tube was then removed. Further surgery proceeded uneventfully. Discussion: By choosing to deliver the proximal end of the inadvertently placed esophageal tube thru the endoscopic port of a Patil-Syracuse mask and mask ventilating the patient, we have been able to provide that few precious minutes of oxygenation to the distressed fetus before delivery. By isolating and venting the stomach thru the esophageal tube we provided maternal air way protection during the initial phase of the delivery. Definitive airway access was obtained as soon as additional help and equipment were available. Conclusion: Difficult airway algorithm while comprehensive, does not address the question of time management. While dealing with a difficult airway in obstetric anesthesia, time is the single most important factor, which will determine the maternal and fetal well being. We in our case report have attempted to answer that question of “time”.
文摘Due to France has suffered from many terrorist attacks and the number of visitors to the Louvre has gradually increased in recent years, a good evacuation plan for the Louvre is of vital significance. We use the minimization of the total evacuation time of all tourists as the optimization goal to find an optimal path. For conventional emergencies, a static model is built to evacuate visitors. And then we establish a nonlinear programming model. Using Lingo software, we get the distribution information of the visitors in different exhibition halls. For unconventional emergencies, we establish an adaptive dynamic model of tourist evacuation based on genetic algorithm. The sensitivity analysis of the model is considered by adding new paths. By solving the nonlinear programming problem with the double objective function of maximizing evacuation time and balancing the number of people in every path, we get the evacuation time last 1582.74 s. Finally, according to our result, we built mathematical models for the evacuation after an emergency and analyzed how to adapt and implement our models for other large and crowded structures.
文摘Emergency C-sections are performed for various reasons. This is a case report of emergency C-section performed due to fetal distress. This is a classic case report which emphasizes the importance of managing emergency C-sections according to international standards and acknowledges co-operation of obstetrician and anesthesiologist. We reviewed literature about emergency C-sections and discussed sensitive time intervals, types of anesthesia and neonatal resuscitation.
文摘AIM To investigate the role of bloodtransfusion in TT viral infection(TTV).METHODS We retrospectively studied serumsamples from 192 transfusion recipients whounderwent cardiovascular surgery and bloodtransfusion between July 1991 and June 1992.Allpatients had a follow-up every other week for atleast 6 months after transfusion.Eightyrecipients received blood before screeningdonors for hepatitis C antibody(anti-HCV),and112 recipients received screened blood.Recipients with alanine aminotransferase level】2.5 times the upper normal limit were testedfor serological markers for viral hepatitis A,B,C,G,Epstein-Barr virus and cytomegalovirus.TTV infection was defined by the positivity forserum TTV DNA using the polymerase chainreaction method.RESULTS Eleven and three patients,whoreceived anti-HCV unscreened and screened'blood,respectively,had serum ALT levels】90 IU/L.Five patients(HCV and TTV:1;HCV,HGV,and TTV:1;TTV:2;and CMV and TTV:1)were positive for TTV DNA,and four of them hadsero-conversion of TTV DNA.CONCLUSION TTV can be transmitted viablood transfusion.Two recipients infected byTTV alone may be associated with the hepatitis.However,whether TTV was the causal agentremains unsettled,and further studies arenecessary to define the role of TTV infection inchronic hepatitis.
