Cerebral Malaria: Epidemiological, Clinical and Prognosis Aspects in the Anesthesia-Resuscitation Department CHU Ignace Deen

Objective: To describe the epidemiological, clinical, paraclinical and prognostic aspects of cerebral malaria received in the anesthesia-resuscitation department. Methodology: This was a prospective descriptive type study carried out in the anesthesia-resuscitation department over a period of three (03) months (June 01 to August 31, 2022). All patients admitted for cerebral malaria were included. Sociodemographic, clinical and prognostic parameters were studied. Results: We collected 25 cases out of 105 admitted patients (23.8%). The average age was 27.6 ± 9.5 years with extremes of 11 and 50 years. The sex ratio was 0.7 (M/F). Students and housewives were in the majority, i.e. 52% and 24%. Neurological disorders were found on admission in all patients, dominated by impaired consciousness at 100% followed by convulsion (60%), prostration (44%), confusion (36%) associated with deep coma in (68%). Gross hemoglobinuria was present in (84%) of cases. On the blood count, anemia was present in (70%) of the patients followed by thrombocytopenia in more than half of the cases (60%) and transfusion was necessary in 19 cases. P Falciparum malaria was found in all patients (100%), the average parasite density was 60342.8 ± 30425.6 trophozoites/μl with extremes of 9000 to 100000 trophozoites/μl. All our patients were treated with intravenous injectable artesunate. Transfusion was performed in 76% of our patients. Eighty percent of the patients had benefited from dialysis. High oxygen therapy was performed in (92%) of cases. The average duration of hospitalization was 5.74 ± days with extremes of 1 to 17 days. Mortality was 48%. Conclusion: Cerebral malaria can take different clinical forms, the most important of which is cerebral involvement. Prompt initiation of appropriate resuscitation can reduce mortality.

Small Bowel Obstruction: Epidemiological, Clinical and Therapeutic Aspects in the General Surgery Department of Hôpital SominéDOLO de Mopti

Small bowel obstruction (SBO) is defined as a complete and persistent cessation of the transit of materials and gases. It occurs in a segment of the digestive tract located between the pylorus and the colorectal junction. We report an observational study which aims to describe the epidemiological, clinical and therapeutic aspects of small bowel obstruction. This study was carried out in the General Surgery Department of Hôpital Sominé DOLO de Mopti from October 1, 2016 to October 1, 2018. A total of 114 patients were recorded for whom the diagnosis was related to an occlusion. The median age was 37 years with extremes ranging from 6 months to 90 years. Male sex was predominant with a sex-ratio of 1.8. The frequency of small bowel occlusions over all occlusions was 74.03%. The most encountered clinical signs were as followed: abdominal pain (100%), vomiting (88.6%), cessation of materials and gas (79.9%) and meteorism (62.3%). All patients underwent medical imaging, the most common of which was an abdomen without preparation X-ray (AWP). On the etiological level, the main causes found postoperatively were: flanges and adhesion (55.2%), strangulated hernias (28.0%), acute intussusception (6.1%), small bowel volvulus (3.5%) and small bowel tumor (1.6%). Releasing the bridles was the most common surgery process (28.0%). The morbidity of the immediate follow-up was (13.1%) and the mortality was (7.0%). This high mortality is due to ignorance of the signs of seriousness and the socio-cultural barrier (decision of the patriarch to agree to a surgical intervention), the late use of hospital facility and the limited financial capability of the patients.

Dosage Formula in Anesthesia for Manual Intrauterine Aspiration Post-Abortion in Resource-Limited Settings

Setting: Provincial General Reference Hospital of Bukavu, General Reference Hospital of Panzi, General Reference Hospital of Ciriri, General Reference Hospital of Nyatende and Biopharm Hospital Center. Objective: Contribute to the improvement of the anesthetic ECP of patients benefiting from MVA for incomplete abortion, Describe the methodology used for adoption of the dosage formula in Anesthesia for MVA, present the mathematical demonstration leading to the dosage formula in anesthesia for MVA. Materials and Methods: Our study was descriptive by mathematical demonstration of obtaining the equilibrium constant of the dosage formula of bipuvacaine 0.1% and Fentanyl 50 µg% adapted to the weight and specific size of patients treated anesthetically in MVA cases for incomplete abortion. We also carried out an operational research by first determining the interval where our equilibrium constant is included and secondly by means of the ends of the intervals found correlated to the ends of intervals of possible weights and sizes in the being normal human female of childbearing age to arrive at the real numerical value of the equilibrium constant of the BUKAVU Dosage Formula in the case of anesthesia for MVA during the management of incomplete abortions. Results: TWO-STAGE OPERATIONAL RESEARCH: • Determination of the interval where the equilibrium constant x = −0.95 x x by crossing the means between the extremes of volumes of anesthetic drugs giving a satisfactory sensory block without hemodynamic disturbance and the extremes of normal weight and height for women of childbearing age. We ended up with X = 0.37. Conclusion: At the end of our study which had the general objectives of contributing to the improvement of the anesthetic PEC of patients receiving MVA for incomplete abortion and specific objectives of describing the methodology used for adoption of the dosage formula in Anesthesia for MVA and present the mathematical demonstration which resulted in the dosage formula in nesthesia for MVA, it appears that the dosage formula of Bukavu, in case of intrathecal spinal analgesia of MVA for incomplete abortion provides precision on the specificity of the doses of bipuvacaine hypobarre 0.1% and Fentanyl 50 µg% reported to each patient according to her weight and height. Its application could therefore reduce morbidity and mortality and improve patient-practitioner comfort in the event of MVA for incomplete abortion following the dosage precision it provides.

The Evolutionary Profile of Patients Operated for Peptic Ulcer Perforation in Bujumbura

Background: The evolutionary profile of patients operated for peptic ulcer perforation in Bujumbura. Perforated peptic ulcer is a serious complication of peptic ulcer with potential risk of grave complications. Aim: To study the early morbidity and mortality of surgery for peptic ulcer perforation in Bujumbura City Hall hospitals: Kamenge University Hospital Center (CHUK), Kamenge Military Hospital (HMK) and Prince Louis Rwagasore Clinic (CPLR). Patients and methods: This is a retrospective, descriptive and analytical study carried out in the three hospitals of Bujumbura over a period of three years from January 1, 2020 to December 31, 2022. It involved 57 cases (n = 57) of peptic ulcer perforation. Results: The frequency of surgery for peptic ulcer perforation was 2.7% with a mean age of 43.6 years +/- 15.3 years and a male predominance with a sex ratio of 3.7. Eight percent of patients presented with shock, 24.5% were smokers, and 67.9% had taken non steroidal anti-inflammatory drugs. The mean hospital stay was 15.2 days with a standard deviation of 12.1. The morbidity rate was 30.2%, 32% were classified in grade IIIb of the Clavien-Dindo Surgical Complications Scale. There were 9 deaths (17%). Seven patients who underwent surgery and received late consultations died. Conclusion: Surgery for peptic ulcer perforation remains an intervention associated with a high rate of morbidity and mortality in Bujumbura. Surgery for peptic ulcer perforation remains a procedure associated with a high morbidity and mortality rate in Bujumbura. The time before consultation was the only factor associated with early morbidity and mortality of Surgery for peptic ulcer’s perforations.

Left Hemispherical Subdural Hematoma on the Same Side as the Motor Deficit (Kernohan)

Chronic subdural hematoma represents 25% of traumatic subdural collections;common in elderly subjects with a clear male predominance. It occurs over the age of 50 in more than 90% of cases and 50% of patients have no history of head trauma even if the latter remains the main risk factor with others such as coagulopathy, anticoagulant treatment, chronic alcoholic poisoning. Its discovery is rarely fortuitous and has an important clinical polymorphism including an intracranial hypertension syndrome (complete or incomplete). We report a clinical case of a left hemispheric subacute subdural hematoma with post-traumatic falcorial involvement in a 70-year-old patient admitted with a picture of impaired consciousness and weakness of the left hemibody. The objective of this work is to draw the attention of neurosurgeons and neurologists to the paradoxical existence of the neurological deficit on the same side as the causal brain lesion.

Morbidity and Mortality of Emergency Hernia Surgery in Adults in Bujumbura: Analysis of Favourable Factors

Background: Abdominal parietal hernia, a temporary or permanent exit of viscera through an anatomically pre-existing zone of weakness, is a frequent pathology in surgery. So, the management of emergency hernias surgery should include some complications most often up after 30 days of the operation. Aim: To analyze the factors contributing to morbidity and mortality after 30 days of emergency hernia surgery in adults in the surgical departments of Bujumbura hospitals. Methodology: This is a prospective study over a period of one year that included all hernias operated on in emergency from January 2022 to February 2023. Results: During the period, 251 patients were admitted to the operating room for abdominal parietal hernias, including 49 for emergency hernia surgery. There were 43 men (87.76%) and 6 women (12.24%), i.e. a sex ratio of 7.1. The average age was 49.6 years, with extremes of 18 and 84 years. The occupation of strength (farmer, labourer, mechanic, mason, mason’s helper) represented 75.51% of the cases. Inguino-scrotal hernia was preponderant (65.31%) followed by inguinal hernia (25.58%), umbilical hernia (4.08%);femoral hernia represented 4.08%. Hernial strangulation represented 89.80% and engorged hernia 10.20%. Morbidity was minor, 2.04% of complications (suppuration, hematoma, urinary retention). No deaths were found. Altemeir stage and occupation were statistically related to morbi-mortality of emergency hernia surgery in adults at 30 days postoperative (p = 0.0028 and p = 0.0284 respectively). Conclusion: Abdominal parietal hernias are frequent, dominated by groin hernias. The high frequency of strangulation calls for awareness of cold hernia cures.

The Bispectral Index Interest during General Anesthesia at the University Hospital of Parakou (Republic of Benin) in 2019

Background: The bispectral index (BIS) derived from the electroencephalogram is an additional means of monitoring the depth of narcosis. Objective: To compare the monitoring of the depth of narcosis by the BIS associated with clinical data versus standard monitoring at the University Hospital of Parakou in Benin in 2019. Methods: This was an observational study for descriptive and analytical purposes with prospective data collection, carried out in general surgery and intensive care unit for 4 months. The inclusion criteria were: an age ≥ 18 years, an ASA score ≤ 3, surgery under general anesthesia and informed consent of the patient. Two groups were formed: non-BIS group monitored by clinical parameters (PA, FC, FR, EtCO2, and SpO2) only and BIS group monitored by bispectral index in addition to clinical parameters. Patients were seen 48 hours after the procedure. Results: 36 patients were collected. The mean age was 40.63 ± 16.77 years with a sex ratio of 3. ASA 1 patients represented 86.11% of the sample and ASA2 patients 13.89%. The average doses of Propofol were not significantly reduced in the BIS group (p = 0.555). On the other hand, the period of intraoperative recovery (p-value = 0.007) and the NVPO (p = 0.043;OR = 0.10;95% CI [0.01 - 0.97]) were significantly reduced by the use of BIS. One case of intraoperative memorization (2.78%) was however found in the BIS group. Conclusion: The bispectral index makes it possible to significantly reduce the risk of intraoperative awakening and PONV, and not significantly reduce the consumption of Propofol.

Perioperative Materno-Fetal Morbimortality Related to the Caesarean in the Hospital Setting in Mali

Introduction: During childbirth by Caesarean, several types of anesthesia can be used. The Caesarean, the most practiced surgical delivery technique in obstetrics, has a risk for complications for both the pregnant women and newborns. Objective: To evaluate the importance of the complications due to Caesarean in the Teaching hospital Gabriel Toure. Patient and Methods: We conducted a cross sectional survey in the departments of intensive care unit and gyneco-obstetric from January to August 2017 in the University hospital Gabriel Touré of Bamako. Our study population was pregnant women who gave birth to children by Caesarean. We included all cases of preventive and emergent Caesarean under loco-regional or general anesthesia. Data were compiled from the obstetrical files of the patients, the anesthetic consultation registry and the databasis of the department of gyneco-obstetric. The test of khi2 of Pearson was used for the comparison of our results with a value of p < 0.05 considered as statistically significant. The consent of the patients or parents was gotten. The survey didn’t include a potentially dangerous act. Results: During the study period, 1875 childbirths have been recorded of which 633 were by Caesarean (33.7%). We collected and analyzed 524 files of Caesarean. The mortality rate was 1.5% in pregnant women and 15% in newborns. The average age was 26.6 ± 6.9 ans. Pregnant women were referrals in 59.4% of the cases. The most frequent motive of referrals was high blood pressure and pregnancy in 66.6%. The Caesarean was indicated in most of the cases on previously operated uterus in 22% and eclampsia was present in 14%. The maternal mortality had occurred in a context of hemorrhage in 50% of the cases. The factors of maternal morbi-mortality were the mode of admission, iterative Caesarean, t surgeon, context of the Caesarean, realization of the anesthetic consultation and the technic of anesthesia (p = 0.05). The factors of fetal mortality were the realization of endo-tracheal intubation, technic of anesthesia, realization of the anesthesia consultation, context of the Caesarean, iterative Caesarean and the mode of admission (p ≤ 0.05). Conclusion: The caesarean is associated with a high risk of maternal complications and a very important fetal mortality. The anesthesia consultation in the follow-up of pregnancy would reduce this high mortality.