Peritonitis: Perioperative Care in Surgical Emergencies CHU Ignace Deen

Objective: Describe the perioperative management of peritonitis in surgical emergencies. Methodology: This was a prospective observational study of the descriptive type over a period of 12 months from January 01 to December 31, 2020 in the surgical emergency room at the CHU Ignace Deen. Included in the study were all patients admitted for peritonitis aged greater than or equal to 18 years. The parameters were epidemiological, clinical and anesthetic. Results: Of the 653 admissions to surgical emergencies in 2020, 185 cases presented with peritonitis, i.e. 29.3%. The average age was 38.6 ± 16.64 years with extremes of 18 and 90 years. The sex ratio was 1.89. The comorbidities were dominated by gastritis and hypertension, i.e. 22%. The patients were classified as ASA 3U (52.4%), ASA2 U (39.5%) and ASA 4 U (8.1%). Preoperative resuscitation was provided only with 100% saline. 25.5% of patients had received a blood transfusion. The response time was less than 48 hours, i.e. 77.6%. General anesthesia was performed for all patients. Ketamine was the most used IV hypnotic (56.3%) combined with 100% halothane. The curares used were suxamethonium at (81.6%), Atracurium (81.6%) and rocuronium at (18.3%). Fentanyl was the only morphine used. Senior anesthesia technicians provided anesthesia in (63.2%). Intraoperative incidents were dominated by hypotension, difficult intubation, cardiac arrest, respectively 10.3%, 8% and 0.5%. The immediate postoperative incidents were arterial hypotension, nausea and desaturation, respectively 52.9%, 80% and 32.4%. Mortality was 3.4%. Conclusion: The perioperative management of peritonitis in the emergency room must be as early as possible in order to reduce morbidity and mortality.

A Game-Theoretic Approach to Safe Crowd Evacuation in Emergencies

Obstacle removal in crowd evacuation is critical to safety and the evacuation system efficiency. Recently, manyresearchers proposed game theoreticmodels to avoid and remove obstacles for crowd evacuation. Game theoreticalmodels aim to study and analyze the strategic behaviors of individuals within a crowd and their interactionsduring the evacuation. Game theoretical models have some limitations in the context of crowd evacuation. Thesemodels consider a group of individuals as homogeneous objects with the same goals, involve complex mathematicalformulation, and cannot model real-world scenarios such as panic, environmental information, crowds that movedynamically, etc. The proposed work presents a game theoretic model integrating an agent-based model to removethe obstacles from exits. The proposed model considered the parameters named: (1) obstacle size, length, andwidth, (2) removal time, (3) evacuation time, (4) crowd density, (5) obstacle identification, and (6) route selection.The proposed work conducts various experiments considering different conditions, such as obstacle types, obstacleremoval, and several obstacles. Evaluation results show the proposed model’s effectiveness compared with existingliterature in reducing the overall evacuation time, cell selection, and obstacle removal. The study is potentially usefulfor public safety situations such as emergency evacuations during disasters and calamities.

Digestive Surgical Emergencies at the “Mother Child”Hospital Center Luxembourg in Mali

Digestive surgical emergencies concern all patients admitted urgently, for whom a decision for surgical intervention may be necessary within 24 hours. They are on guard duty day and night. To carry out this work, we set ourselves the objectives of: 1) Studying digestive surgical emergencies in the general surgery department of the “Mother Child” Le Luxembourg hospital in Bamako, Mali;2) Determine the frequency of digestive surgical emergencies, 3) Describe the clinical and therapeutic aspects, and 4) Analyze the results of treatment. From November 1, 2022 to October 31, 2023, the general surgery department of the “Mother Child” Luxembourg Hospital Center in Bamako, Mali, carried out 139 digestive surgical emergencies whose files were usable;75 men and 64 women, a sex ratio of 1.2. The 20 - 40 years old age group was the most represented, at 40.29%. The average age was 39 years;the extremes 16 years and 93 years with a standard deviation of 21.65 years. The reference concerned 51.08% of our patients. Abdominal pain was the main reason for consultation (100% of cases). In the majority of cases, the physical examination made it possible to make the diagnosis. Faced with certain clinical cases, we requested ultrasound (109/139), ASP (46/139) and CT (15/139). The main etiology was acute appendicitis with 42.45% of cases. The frequency of digestive surgical emergencies was 10.71% of all activities in the general surgery department of the “Mère Enfant” Le Luxembourg hospital center in Bamako. All our patients were seen in consultation by an anesthesiologist before entering the operating room. The surgical consequences were complicated in 11.51% of cases with 7.91% deaths. Surgical site infections accounted for 12.5% of postoperative complications. Eleven deaths were noted, representing 68.75% of complications and 7.91% of our sample. Acute peritonitis was the cause of death in 100% of cases. The average cost of care was 329,000 FCFA.

Tuberculous peritonitis complicated by an intraperitoneal tuberculous abscess: A case report

BACKGROUND Tuberculous peritonitis(TBP)is a chronic,diffuse inflammation of the peritoneum caused by Mycobacterium tuberculosis.The route of infection can be by direct spread of intraperitoneal tuberculosis(TB)or by hematogenous dissemination.The former is more common,such as intestinal TB,mesenteric lymphatic TB,fa-llopian tube TB,etc.,and can be the direct primary lesion of the disease.CASE SUMMARY We present an older male patient with TBP complicated by an abdominal mass.The patient's preoperative symptoms,signs and imaging data suggested a poss-ible abdominal tumor.After surgical treatment,the patient's primary diagnosis of TBP complicating an intraperitoneal tuberculous abscess was established by com-bining past medical history,postoperative pathology,and positive results of TB-related laboratory tests.The patient's symptoms were significantly reduced after surgical treatment,and he was discharged from the hospital with instructions to continue treatment at a TB specialist hospital and to undergo anti-TB treatment if necessary.CONCLUSION This case report analyses the management of TBP complicated by intraperitoneal tuberculous abscess and highlights the importance of early definitive diagnosis in the hope of improving the clinical management of this type of disease.

REDISSE in Benin and Lessons Learned for the Management of Public Health Emergencies after Five Years of Implementation

Introduction: Benin was embarked on phase 3 of the REDISSE Benin project (Regional Disease Surveillance Systems Enhancement) which began in 2018. The objectives were in five key components namely, Surveillance and health information;Laboratory capacity building;Emergency preparedness and response;Human resources management for effective disease surveillance and epidemic preparedness;and Institutional Capacity Building, Project Management, Coordination and Advocacy. After five years of implementation, this study aimed at the documentation of lessons learned and best practices. Methods: A descriptive cross-sectional study. Apart from individual semi-structured interviews, a thematic workshops bringing together the project’s main stakeholders recruited on an exhaustive way by component to identify and validate lessons learned, good practices and propose improvement mechanisms to be taken into account by the sector. Criteria were set up and used to validate best practices and lessons learned. Results: A total 54 (Surveillance workshop), 47 (Preparedness & response workshop), 53 (Human Resources workshop), 26 (Laboratories workshop) participated to the thematic workshops, and five interviews. The good practices (33: 9 for animal health, 7 for human health and 17 crosscutting) and lessons learned (10: 3 for animal health and 7 for human health) have been identified and have been the subject, depending on the case, of proposals for improvement or conditions necessary for their maintenance. Discussion: The richness of a project lies not only in the immediate achievement of its results, but also and above all, in its usefulness for similar interventions, whether in the local, regional, national or international context. It is in this context that the REDISSE project has set out to make public the various lessons learned and best practices from the implementation of its activities over a period of some five consecutive years.

Obstetric Emergencies at the Kara University Hospital Maternity Ward: Sociodemographic, Etiological and Prognostic Aspects

Introduction: Obstetric emergencies are common throughout the world and more particularly in developing countries where they are responsible for high maternal-fetal mortality and morbidity. Objective: Study obstetric emergencies in the maternity ward of Kara University Hospital. Method: Retrospective and descriptive study from April 1, 2022 to March 30, 2023, carried out in the Obstetrics and Gynecology Department of Kara University Hospital. Results: Eight hundred and thirty-five (835) obstetric emergencies were recorded out of 2215 admissions, i.e. a frequency of 37.7%. The average age of the patients was 26.7 with a range of 14 and 45 years. They were primigravidas (36.7%) and nulliparous (38.7%), referred (84.7%) and came from rural areas (72%). Emergencies occurred in the 3rd trimester in 74.1% and in parturients (54.1%). Preeclampsia (27%), cessation of progression of labor due to feto-pelvic disproportion (12.4%), postpartum hemorrhage (7.5%) constituted the main obstetric emergencies. In 44.8%, the delivery was carried out vaginally. Magnesium sulfate was the most used drug, i.e. 30.1%;followed by antihypertensive medications in 28.1%. Blood transfusion was performed in 24.3%. The evolution was simple in 90.9%. The maternal fatality rate was 1.6%. The perinatal case fatality rate was 12.3%. Conclusion: Obstetric emergencies are common, dominated by preeclampsia, stopping progress of labor and postpartum hemorrhages. They are responsible for high morbidity and mortality.

Sensitivity of diagnosis of spontaneous bacterial peritonitis is higher with the automated cell count method

BACKGROUND Spontaneous bacterial peritonitis(SBP)is one of the most important complications of patients with liver cirrhosis entailing high morbidity and mortality.Making an accurate early diagnosis of this infection is key in the outcome of these patients.The current definition of SBP is based on studies performed more than 40 years ago using a manual technique to count the number of polymorphs in ascitic fluid(AF).There is a lack of data comparing the traditional cell count method with a current automated cell counter.Moreover,current international guidelines do not mention the type of cell count method to be employed and around half of the centers still rely on the traditional manual method.AIM To compare the accuracy of polymorph count on AF to diagnose SBP between the traditional manual cell count method and a modern automated cell counter against SBP cases fulfilling gold standard criteria:Positive AF culture and signs/symptoms of peritonitis.METHODS Retrospective analysis including two cohorts:Cross-sectional(cohort 1)and case-control(cohort 2),of patients with decompensated cirrhosis and ascites.Both cell count methods were conducted simultaneously.Positive SBP cases had a pathogenic bacteria isolated on AF and signs/symptoms of peritonitis.RESULTS A total of 137 cases with 5 positive-SBP,and 85 cases with 33 positive-SBP were included in cohort 1 and 2,respectively.Positive-SBP cases had worse liver function in both cohorts.The automated method showed higher sensitivity than the manual cell count:80%vs 52%,P=0.02,in cohort 2.Both methods showed very good specificity(>95%).The best cutoff using the automated cell counter was polymorph≥0.2 cells×10^(9)/L(equivalent to 200 cells/mm^(3))in AF as it has the higher sensitivity keeping a good specificity.CONCLUSION The automated cell count method should be preferred over the manual method to diagnose SBP because of its higher sensitivity.SBP definition,using the automated method,as polymorph cell count≥0.2 cells×10^(9)/L in AF would need to be considered in patients admitted with decompensated cirrhosis.

Urological Emergencies at the University Hospital of Brazzaville: Epidemiological, Clinical, and Therapeutic Aspects

Introduction: Urological emergencies play a significant role in the medical and surgical activity of a urology department. The objective of this study was to determine the hospital prevalence of urological emergencies at the University Hospital of Brazzaville (CHUB), identify the different pathologies requiring urgent care, and list the various therapeutic methods. Patients and methods: A retrospective study of patients admitted to the medical and surgical emergencies department of CHUB over a 5-year period. Patient records admitted and treated for a urological emergency were included. The variables studied were the frequency of urological emergencies, patient age at admission, gender, nature of the emergency, and various therapeutic options. Results: Urological emergencies accounted for 4.3% of all medical and surgical emergencies. The mean age was 57 ± 28 years with a range of 3 to 93 years. The male-to-female ratio was 7.1. The most common conditions were urinary retention (54.67%), hematuria (17.20%), and renal colic (8.13%). Therapeutically, surgical urinary drainage was dominated by cystostomy. Conclusion: Urological emergencies are infrequent at the University Hospital of Brazzaville. Their management is often delayed.

Infectious ENT Emergencies: A One-Year Experience at the ENT Department of Mamou Regional Hospital

Introduction: ENT infectious emergencies encompass all infectious pathologies affecting the ear, nose, sinuses, throat, and neck. A good understanding of these emergencies is essential for organizing appropriate care. In Guinea, few studies have described ENT infectious pathologies in rural areas. Objective: To study ENT infectious emergencies in the Otorhinolaryngology department of the Mamou Regional Hospital. Materials and Methods: This is a retrospective and prospective descriptive study, conducted from August 1, 2021, to July 31, 2022. All patients admitted to the ENT department of the Mamou Regional Hospital for an infectious emergency were included. Results: Among the 1854 recorded consultations, 261 cases involved ENT infectious emergencies, representing a prevalence of 14.07%. The most represented age group was 0 to 10 years (31.03%), with a majority of female patients (59%) and a predominantly urban origin (81.61%). Students accounted for 32.18% of the cases. The main reasons for consultation were odynophagia/dysphagia (32.42%) and otalgia (22.94%). The primary etiologies were tonsillitis (28.73%) and otitis (27.20%). Treatments administered included probabilistic antibiotic therapy (38.80%), analgesics (32.03%), and corticosteroid therapy (10.47%). The outcome was favorable in 98.85% of cases, with only 0.38% lost to follow-up. Conclusion: The results of our study confirm the frequency of ENT infectious pathologies. Their management requires joint actions for population awareness, staff training, and services equipment, particularly in rural areas.

Comprehensive Review:Diagnosis,Classification,and Risk Factors of Peritoneal Dialysis-Associated Peritonitis

Peritoneal dialysis(PD)is a predominant modality of renal replacement therapy(RRT)for individuals suffering from end-stage renal disease(ESRD).Peritoneal dialysis-associated peritonitis(PDAP)represents a frequent complication among patients undergoing PD,significantly contributing to adverse clinical outcomes.This review comprehensively examines the diagnosis,classification,and risk factors associated with PDAP,aiming to offer clinical practitioners essential guidance and a foundational framework for effective clinical management.

Neisseria mucosa-A rare cause of peritoneal dialysis-related peritonitis:A case report

BACKGROUND Neisseria mucosa is a gram negative diplococcus belonging to the genus Neisseria found commonly in the upper respiratory tract.It is typically a commensal organism when it is parasitic on oral and nasal mucosa.To our knowledge,it does not cause disease in healthy individuals with normal immunity,but can be pathogenic in those with impaired immune function or change in bacterial colonization site.Neisseria mucosa has been reported to cause bacterial meningitis,conjunctivitis,pneumonia,endocarditis,peritonitis and urethritis.However,peritoneal dialysis-related peritonitis caused by Neisseria mucosa is extremely rare in clinical practice,which has not previously been reported in China.CASE SUMMARY A 55-year-old female presented to the nephrology clinic with upper abdominal pain without apparent cause,accompanied by nausea,vomiting and diarrhea for two days.The patient had a history of Stage 5 chronic kidney disease for five years,combined with renal hypertension and renal anemia,and was treated with peritoneal dialysis for renal replacement therapy.The patient was subsequently diagnosed with peritoneal dialysis-related peritonitis.Routine examination of peritoneal dialysis fluid showed abdominal infection,and the results of microbial culture of the peritoneal dialysis fluid confirmed Neisseria mucosa.Imi-penem/cilastatin 1.0 g q12h was added to peritoneal dialysis fluid for anti-infection treatment.After 24 d,the patient underwent upper extremity arteriovenous fistulation.One month later,the patient was discharged home in a clinically stable state.CONCLUSION Peritonitis caused by Neisseria mucosa is rare.Patients with home-based self-dialysis cannot guarantee good medical and health conditions,and require education on self-protection.

Current concepts and future strategies in the antimicrobial therapy of emerging Gram-positive spontaneous bacterial peritonitis

Spontaneous bacterial peritonitis(SBP) is the most common infection in end-stage liver disease patients.SBP is defined as an ascitic fluid infection with a polymorphonuclear leucocyte count ≥ 250/mm^3 without an evident intra-abdominal surgically treatable source.Several mechanisms contribute to SBP occurrence,including translocation of gut bacteria and their products,reduced intestinal motility provoking bacterial overgrowth,alteration of the gut's barrier function and local immune responses.Historically,Gram-negative enteric bacteria have been the main causative agents of SBP,thereby guiding the empirical therapeutic choice.However,over the last decade,a worryingly increasing prevalence of Gram-positive and multi-drug resistant(MDR) SBP has been seen.Recently,the microbiological spectrum of SBP seems to have changed in Europe due to a high prevalence of Gram-positive bacteria(48%-62%).The overall proportion of MDR bacteria is up to 22%-73% of cases.Consequently,empirical therapy based on thirdgeneration cephalosporins or amoxicillin/clavulanic acid,can no longer be considered the standard of care,as these drugs are associated with poor outcomes.Theaim of this review is to describe,with an epidemiological focus,the evidence behind this rise in Gram-positive and MDR SBP from 2000 to present,and illustrate potential targeted therapeutic strategies.An appropriate treatment protocol should include daptomycin plus ceftaroline and meropenem,with prompt stepdown to a narrower spectrum when cultures and sensitivity data are available in order to reduce both cost and potential antibiotic resistance development.

Acute Peritonitis at the Reference Health Center of Commune I of the District of Bamako: Epidemiological, Clinical and Therapeutic Aspects

Acute peritonitis is most often secondary to perforation of the digestive organ and/or the spread of an intra-abdominal septic focus. The objectives of this work were to study acute peritonitis in the general surgery department of the Cs ref of commune I in Mali, to determine the frequency of peritonitis, to describe the epidemiological, clinical and therapeutic aspects in order to analyze the surgical consequences and to assess the additional cost of treating acute peritonitis. This study was prospective, descriptive, cross-sectional involving 40 patients received in the surgery department of the Cs ref of commune I for acute peritonitis from January 1, 2018 to December 31, 2018. There were 40 patients among whom 28 (70%) were men and 12 were women (30%), i.e. a sex ratio = 2.3. The average age was 25 years with extremes varying between 16 and 54 years and a standard deviation of 11.78. Abdominal pain was the main reason for consultation. Clinical examination alone made it possible to make the diagnosis in 75% of cases. Surgical treatment depended on the intraoperative etiology. The clinical diagnosis was supported by ASP and abdominal ultrasound;performed respectively in 10% and 90% of patients. Appendiceal peritonitis was the intraoperative diagnosis observed in 50% of cases. All our patients benefited from a peritoneal toilet with drainage. We noted a morbidity rate of 5% dominated by parietal suppuration. The average cost of care was 175,000 FCFA.

The Place of Blood Transfusion in the Management of Obstetric Emergencies in the Gynaecology and Obstetrics Department of the Reference Health Center of Fana (Mali)

This is a prospective and descriptive study carried out at the gynecology and obstetrics department of the reference health center of Fana from 01 May 2019 to 30 November or 7 months. The main objective was to study the role of blood transfusion in the management of obstetric emergencies. During the study period we recorded 434 cases of obstetric emergencies of which 116 cases required an emergency blood transfusion or 26.73%. The most frequently found indications for blood transfusion are hemorrhages of the immediate postpartum 46.6% followed by severe malaria on pregnancy 27.6%. Blood remains the most prescribed and available Labile blood product in the department. Maternal prognosis was improved in 92.2%.

Study of the Management of Children with Major Sickle Cell Disease in Pediatric Emergencies at the Gabriel Toure University Hospital

Objective: To study the epidemiological, clinical and therapeutic aspects of sickle cell disease in children admitted to the pediatric emergency department of the Gabriel Toure University Hospital. Materials and methods: This was a prospective study over 12 months in sickle cell children aged 6 months to 15 years. Results: The frequency of sickle cell disease was 4.67% with 71.1% of SS form. The age range of 60 - 120 months predominated with 43.4% and the sex ratio 1.4. Vaso-occlusive crises (VOC) were the most frequent reason for consultation (50.6%) and osteoarticular pain was the main symptom followed by fever and pallor with respectively 67.5%, 60.2%, 39.8%. The pain subsided in less than 72 hours in 39.8% and hyper hydration was performed in 85.1% of patients. Analgesic treatment was given in 90.4%, antibiotic therapy in 51.8% and phenotyped red blood cells transfusion was performed in 36.1%. The average duration of treatment was 10 days. Conclusion: Vaso-occlusive crisis remains the main reason for consultation in sickle cell disease children at Gabriel Toure University Hospital. The management consisted, in addition to the correction of the triggering factors, of hyper hydration and the administration of analgesics and blood products.

Acute Peritonitis at the CSRef of the Commune I in the District of Bamako: Signs, Diagnosis and Treatment

Acute generalized peritonitis is an acute inflammation of the peritoneum. It is most often secondary to perforation of the digestive organ and/or the spread of an intra-abdominal septic focus. The absence of a study on peritonitis in a reference health center motivated us for this work. The aim of this study was to study the inadequacies that could be seen in the management of peritonitis in the CSRef(s). We carried out a retrospective study of 40 patients received at the CSRéf of commune I for acute generalized peritonitis from 2011 to 2012. The average age was 30.1 years with a standard deviation of 3.4;extremes ranging from 14 years to 60 years and a Sex ratio = 1.22 (22 men out of 18 women). Abdominal pain was the main reason for consultation (present in all our patients). In most cases, clinical examination alone made it possible to make the diagnosis. Surgical treatment depended on the etiology (appendectomy associated with washing-drainage was the most commonly performed surgical procedure). All our patients received general anesthesia. The average length of hospitalization was 7 days with extremes ranging from 1 to 15 days. We noted a Morbidity rate of 22.5%, dominated by wall abscesses and a mortality of 2.5%. The delay in consultation and referrals constitutes a factor in mortality and high morbidity.

Triage and Risk Concept: Application Proposal for Pre-Hospital Emergencies in a Psychiatric Ambulance in the City of Buenos Aires

The heterogeneity of clinical presentations in psychiatric emergencies creates difficulties in the response by interdisciplinary Mental Health teams. This is aggravated and difficult when the care is carried out on public roads or the patient’s home, that is, it is a pre-hospital context. Our Psychiatric Emergency Hospital, located in the City of Buenos Aires, provides pre-hospital care with a psychiatric ambulance, which is then referred to general hospitals or other health system providers. Not all effectors in the network have the same resources and, at the time of the emergency, the reasons for consultation such as the patient’s clinic are heterogeneous and require the greatest effectiveness in the intervention that is taken. The triage system is a resource that allows the systematization of approaches against the multiplicity of reasons for consultation and presentation of mental pathologies in the emergency room, in addition to providing greater effectiveness in interventions, homogeneity for the health system and consensus among the health effectors. Framed in the Mental Health Law, and especially in the concept of risk, a triage proposal was designed for pre-hospital interventions by the psychiatric ambulance dependent on Hospital Alvear and under current legal regulations with the aim of homogenizing care and referrals with the highest rate of effectiveness to provide quality interdisciplinary medicine.

Urological Emergencies at Kara Teaching Hospital (Togo): Epidemiological, Clinical and Therapeutic Profile

Background: The urology department of the teaching hospital of Kara is the second urology department in Togo, after that of the teaching hospital Sylvanus Olympio, in Lomé the capital. It is a very young service, created less than 5 years ago. Urological emergencies were previously managed by general surgeons, for lack of urologists. The influx of patients with urological pathologies has increased with the arrival of urologists. The update on urological emergencies having been made in Lomé, we therefore wanted to take stock of urological emergencies at the teaching hospital of Kara. Objective: To describe the epidemiological, clinical, and therapeutic aspects of urological emergencies received at the teaching hospital of Kara. Patients and Methods: This was a descriptive study with retrospective data collection. The study took place in the urology department, and in the surgical emergency department of the teaching hospital of Kara, over a period of 18 months, from January 2021 to June 2022. The on-call medical team consisted of the intern in on-call medicine, and an on-call urologist, whom the intern called upon when he received a urological emergency. Pediatric urological emergencies were managed by the pediatric surgeon and were not considered in our study. The operating room register, the surgical emergency consultation register, the urology department consultation register, and the records of patients hospitalized in the urology department were used for data collection. The following parameters were studied: age, sex, type of urological emergency, and therapeutic management;epi info 7 software was used for data processing. Results: The average age of the patients was 52.5 ± 19.6 years with extremes ranging from 16 years to 102 years. Note that 57.7% of the patients were over 50 years old. The sex ratio was 8.9. Urinary retention was the most common urological emergency in 47.7% (52) of cases;follow-up of infectious pathologies in 30.2% (33) of cases. Among the patients who had been seen for urinary retention, 84.6% (44) of the cases had presented with acute urinary retention. Urethral catheterization was the type of care most received by patients, in 30.2% (33) of cases;follow-up of medical treatment in 27.5% (30) of cases. The most common etiology of urinary retention was prostate tumours, in 71.1% (37) of cases, followed by urethral stricture in 15.3% (8) of cases. We also found in our series, traumatic emergencies in 10% of cases;these were traumatic urethral injuries, traumatic injuries of external genitalia, traumatic injury of bladder, and traumatic injury of kidney in respectively: 4.5% (5);2.7% (3);1.8% (2);and 0.9% (1) of cases. Torsion of the spermatic cord was found in 2.7% (3) of cases. Conclusion: Urine retention is the most common urological emergency at Kara University Hospital. They are most often found in elderly males. Urethral catheterization was the most common type of care.

Conservative management of multi-trauma induced peritonitis:Experience,outcomes,and indications

BACKGROUND The concept of mandatory laparotomy in treating traumatic peritonitis has been increasingly questioned recently.AIM To summarize and share the experience of conservative treatment of patients with multi-trauma induced peritonitis.METHODS A retrospective review was performed on patients with multiple injury induced traumatic peritonitis.RESULTS A total of 184 patients with multiple injury induced traumatic peritonitis were reviewed.46 of them underwent conservative treatment.None of the 46 patients with conservative treatment switched to surgical treatment,and all of them were cured and discharged after successful conservative treatment.No significant abnormal findings were observed at regular follow-up after discharge.CONCLUSION Conservative management is safe,effective,feasible,and beneficial in hemodynamically stable patients with traumatic peritonitis if there is no definite evidence of severe abdominal visceral organ injury.

Obstetric Emergencies: Frequency, Socio-Demographic Aspects and Risk Factors at the Labe Regional Hospital Maternity Unit (Guinea)

Introduction: Obstetric emergencies are clinical situations of a serious nature, often dangerous, which develop unexpectedly, threatening the vital prognosis of the mother and/or foetus in the short term. The aim of this study was to contribute to a review of obstetric emergencies at the Labé Regional Hospital maternity unit. Methods: This was a prospective descriptive and analytical study conducted over a period of 6 months in the maternity unit of the Labé Regional Hospital. It concerned all patients admitted to the department for obstetric emergencies. Results: Obstetric emergencies accounted for 20% of obstetric admissions. The mean age of the patients was 25.12 ± 7.15 years, with extremes of 14 and 45 years. The patients were housewives (42.52%), 42.86% did not attend school and 77.41% were from urban areas. The poor were the most numerous (43.52%). The ambulance was the means of transport in only 9% of cases. Acute foetal distress, pre-eclampsia, bony dystocia and post-partum haemorrhage were the most common types of emergency in our series, with frequencies of 27.57%, 22.59%, 17.94% and 10.63% respectively. The risk factors identified were age, origin, gestational age and the state of the maternal pelvis. Conclusion: Obstetric emergencies are frequent in our study site and represent a major concern for patients, providers and the community alike. In order to reduce the frequency of obstetric emergencies, young girls should be enrolled in school, the legal age for marriage should be respected, quality antenatal care should be provided in basic health facilities, and proper planning and spacing of pregnancies should be implemented.