Obstetric Anesthesia Practice Significantly Evolved: A Field for Cesarean Delivery Parturient for the Provision of Safe Anesthesia in Urgent Circumstances

General anesthesia and Obstetric Anesthesia is the gold standard for a cesarean section but there are some cases where general anesthesia is unavoidable. The use of general anesthesia for cesarean delivery has decreased in recent years due to the widespread use of neuraxial techniques. The choice of anesthesia techniques for cesarean delivery depends on several factors, including the patient’s psychology and the attending physician’s experience. It is chosen because of its safety profile and its benefits to the mother and fetus. It may be indicated due to emergency, maternal refusal of regional techniques, or regional contraindications. Major complications include failed intubation, gastric content aspiration, and increased bleeding risk. This study aims to evaluate the impact of a newly launched team on obstetric anesthesia practice.

Epidemiological and Computed Tomography Aspects of Facial Trauma at Kira Hospital in Bujumbura

Background: Maxillofacial trauma affects young adults more. The injury assessment is difficult to establish in low-income countries because of the imaging means, particularly the scanner, which is poorly available and less financially accessible. The aim of this study is to describe the epidemiological profile and the various tomodensitometric aspects of traumatic lesions of the face in patients received in the Radiology department of Kira Hospital. Patients and methods: This is a descriptive retrospective study involving 104 patients of all ages over a period of 2 years from December 2018 to November 2019 in the medical imaging department of KIRA HOSPITAL. We included in our study any patient having undergone a CT scan of the head and presenting at least one lesion of the facial mass, whether associated with other cranioencephalic lesions. Results: Among the 384 patients received for head trauma, 104 patients (27.1% of cases) presented facial damage. The average age of our patients was 32.02 years with extremes of 8 months and 79 years. In our study, 87 of the patients (83.6%) were male. The road accident was the circumstance in which facial trauma occurred in 79 patients (76% of cases). These injuries were accompanied by at least one bone fracture in 97 patients (93.3%). Patients with fractures of more than 3 facial bones accounted for 40.2% of cases and those with fractures of 2 to 3 bones accounted for 44.6% of cases. The midface was the site of the fracture in 85 patients (87.6% of cases). Orbital wall fractures were noted in 57 patients (58.8% of cases) and the jawbone was the site of a fracture in 50 patients (51.5% of cases). In the vault, the fractures involved the extra-facial frontal bone (36.1% of cases) and temporal bone (18.6% of cases). Cerebral contusion was noted in 41.2% of patients and pneumoencephaly in 15.5% of patients. Extradural hematoma was present in 16 patients and subdural hematoma affected 13 patients. Conclusion: Computed tomography is a diagnostic tool of choice in facial trauma patients. Most of these young patients present with multiple fractures localizing to the mid-level of the face with concomitant involvement of the brain.

Chest Trauma at the Emergency Department of the Gabriel TouréUniversity Hospital Bamako, Mali

In Mali, chest injuries remain a real public health problem and are associated with heavy morbidity and mortality. Faced with a resurgence of urban civil violence and the explosion of road accidents, we decided to conduct this study in order to describe the epidemiological, clinical and therapeutic aspects of thoracic trauma in the emergency department. Method and Material: This is a descriptive prospective study over a period of one year in the emergency department of the CHU Gabriel Touré. Including all patients admitted for thoracic trauma. Analysis and Entry: Data were entered and analyzed on SPSS software version 20.0. The test was significant for a p value < 0.05. Results: We recorded 21,090 appeals in our structure among which 1284 patients were suspected of thoracic trauma. The diagnosis of thoracic trauma was retained in 119 (0.56%) patients. All patients were transported to the emergency room without prehospital medicalization. Clinical presentation was dominated by dyspnea in 54.6% of patients, however pain was the almost constant symptom in conscious victims. Various traumatic mechanisms had caused these lesions of the thorax, of which road traffic accidents represented half of the causes, followed by urban civil violence in 28.6% of patients. Landslides and falls from a great height were responsible for 19.5% of chest injuries. Open chest trauma was the type of lesion found in a third of the cases. This type of injury was exclusively due to blows and injuries during the brawls. Standard chest radiography was performed as the first intention in 60% of patients compared to 10.9% for the pleuropulmonary ultrasound. Thirteen patients required ventilatory assistance after orotracheal intubation. The average length of stay was 65.23 hours. During the period of our study, the overall mortality was 1.85% in the emergency departments with a lethality specific to chest trauma of 15%. Conclusion: Urban violence with its share of ballistic wounds determined the severity of this condition.

Abdominal Trauma Management: About 62 Cases at the Department of General Surgery of Hôpital SominéDOLO de Mopti, Mali

We undertook a prospective and descriptive observational study on abdominal trauma from February 1, 2016 to August 31, 2017. The aim of this work was to identify the typology and management of abdominal trauma cases in our surgery department. Overall, abdominal trauma represented 3.54% (62/1751) of all surgeries during the study period. Among the 62 cases, men accounted for 59 and women for 3. The sex ratio was 19.67. The mean age was 24 ± 15 years. Road accidents were the most represented with 43.5% of cases. The couple of signs, hypovolemic shock and abdominal pain and decrease on blood pressure were the prominent clinical symptoms with 100.0%, and 50.0% of cases, respectively. Abdominal ultrasound and abdominal x-ray without contrast were performed in 67.0% and 18.0% of cases, respectively. Abdominal trauma was divided into two entities: contusion 68% and wounds 32%. Medical treatment was sufficient in 23.00% of cases. Laparotomy as a surgical approach was performed in 77.0% of cases. Local hemostasis plus drainage (27.08%), splenectomy (25.00%), suture (14.58%), hemostasis by tamponade (8.33%) and colostomy (2.08%) were undertaken as surgical procedures when it came to deal with contusions. Debridement of wounds plus suture and hemostasis by tamponade was performed in 18.73% and 4.16 cases, respectively. The most observed lesions were those of the spleen with 27.42% and those of the small bowel with 24.19%. The postoperative follow-up was straightforward in 83.33% of cases. The overall mortality was 4.17%.

Surgical Management of Larges Goiters in the ENT Department of CHU Mother and Child“Luxembourg”

Objectives: To study the clinical and therapeutic profiles of voluminous goiter. Patients and Methods: We carried out a descriptive and prospective study, relating to a series of 30 cases of voluminous goitre, collected in the Department of Otorhinolaryngology and cervicofacial surgery (ENT and CCF) of the CHU Luxembourg Mother Child of Bamako. It has been spread over a period of 4 years from January 2015 to December 2018. Patients of all ages operated for large goitre at the ENT Department of CHU Luxembourg Mother Enfant were included. Results: In 4 years we collected 30 cases of voluminous goitre;during this period we realized 180 thyroidectomies, i.e. frequency of 16.67%. The average age was 51.37 years with an extreme ranging from 38 to 65 years. Females were common in 66.7% with a sex ratio of 0.50. The long duration of evolution has been 40 years. The sign of compression was found in 85.7%. The physical examination found a mobile swelling, hard and painless in all patients with normal endolaryngeal examination;there was no cervical lymphadenopathy. The lower dipping pole was found in 5 cases on CT. All our patients were euthyroid. The classification of TIRADS 2 was found in 80.0% of cases. Total thyroidectomy was frequent with 50.0% of cases. The average weight of the operative specimen was 586.67 g with extremes ranging from 500 g to 800 g. The size of the operative piece of 14 cm was the longest. Injury of internal jugular vein was found in 26.7% of cases. Colloid adenoma of the thyroid was found in 100% of cases, postoperative complications of the type of hematoma of the lodge in 3.3% of cases, the release of the operative wound in 10% of cases local superinfection in 7.1%. Signs of hypothyroidism were common with 50.0%. Postoperative nasofibroscopy found good vocal fold mobility in all patients. Conclusion: The large goiters have become rare because of the early management of thyroid nodule. Its management must allow the prevention of recurrent and parathyroid morbidity.

Epidemiological, Clinical, Paraclinical and Therapeutic Profile of Prostate Tumors at Panzi Hospital, Democratic Republic of the Congo

Tumor pathologies of the prostate gland are represented by benign prostate tumor and prostate cancer and are generally seen after 50 years. The objective of this work was to study the epidemiological, clinical, paraclinical and therapeutic aspects of prostate tumors at the General Reference Hospital of Panzi (DRC). Patients and Methods: Retrospective cross-sectional study on 70 patients followed in hospital or on an outpatient basis for prostate tumor in the urology department of the General Reference Hospital of Panzi from January 1, 2013 to December 31, 2017. The epidemiological, clinical and paraclinical parameters (pathology with Gleason score, prostate volume on ultrasound, urinary impact on ultrasound, urea level, creatinine level and PSA level) and therapeutics were studied. Results: Prostate tumors represent 3.84% of surgical pathologies. The average age of the patients was 68.2 years with the extremes of 47 and 90 years old. The patients were transferred in 78.6% of the cases. Acute urine retention was the most common reason for consultation with 42.8%. The PSA rate > 4 ηg in 92.9% of the cases. Benign prostatic hyperplasia was found in 62.8% of patients against 35.7% of prostate adenocarcinoma and 41.7% of prostate cancers were moderately differentiated. The prostate volume was 41 - 60 g in 35.7% of the cases. No urinary impact in 71.4% of patients. Surgical treatment was in 85.7% and RTUP was the most used at 40%. A hospital stay between 15 and 21 days in 30% of cases. The cure rate was 81.4% and 14.3% developed urethral stenosis. Conclusion: Prostate tumors are common in people over the age of 50 who see for acute retention of urine. Benign enlarged prostate is the most common. Treatment is codified and in the event of a complicated prostatic tumor, surgery remains the choice for the comfort of the patients and the popularization of an early detection of these pathologies is necessary for the prevention of complications.

Treatment of Pelvic Limb Fractures in a Hospital of 2e Reference in Mali

Introduction: A fracture is a solution in the continuity of a bone. Pelvic limb fractures may involve one or more of the bones. They constitute a real public health problem, which requires the identification of the factors inherent to this phenomenon for better prevention, but also for quality management of fractures and sequelae. Objectives: Were to describe the epidemiological, clinical and therapeutic profile of pelvic limb fractures in Timbuktu Hospital. Patients and Method: We conducted a prospective, descriptive study in the Surgery Department of Timbuktu Hospital, covering a period of one year from January 1 to December 31, 2017. We collected 39 patients who presented with fractures of the pelvic limbs, who were hospitalized and monitored throughout our study. Results: We obtained a hospital frequency of 2.86% limb fractures. Among the 39 patients included in our study, the male sex was predominant in 69.2% of cases, the average age of our patients was 20.5 years. Pupils and students were in the majority in 48.7% of cases. Road traffic accidents were the most common cause of fracture with 59.0% of cases. The tibia was the most affected segment in 38.5% of cases. Surgical treatment was predominant in 64.0% of cases. We obtained very good results in 94.87% of cases. Conclusion: Limb fractures remain frequent due to road traffic accidents. Osteosynthesis treatment provides a good result with fewer complications.

Diagnosis Delay and Assessment of the Quality of Life of Patients with Endometriosis Using the Endometriosis Health Profile 5 Questionnaire in a Sub-Saharan Population

Context: Endometriosis is a pathology that directly affects the daily lives of women with frequent impairment of their quality of life. In our environment, medical, socio-cultural, financial factors and factors related to the organization of the health care system greatly delay its diagnosis. The objectives of the present study were to determine the diagnosis delay and to assess the quality of life before surgery of women with endometriosis using the specific Endometriosis Health Profile 5 (EHP-5) questionnaire. Methods: We carried out a descriptive, observational, retrospective study in 8 medical centers in the City of Kinshasa, from January 2019 to October 2022. A total of 80 women with endometriosis confirmed by laparoscopy (16 diagnostic and 64 operative laparoscopies) and histopathology were interviewed. We used the revised American Society for Reproductive Medicine (rASMR) classification, the Endometriosis Fertility Index (EFI) score was calculated for infertile women and the EHP-5 questionnaire to assess quality of life. Our data was entered and analyzed using Statistical Analysis Software 16.1 (STATA 16.1). Results: Diagnosis delay of endometriosis was on average 12 ± 4.3 years. The overall mean EHP-5 score of all patients showed a severe deterioration in quality of life (604 ± 235). A negative relationship was observed between the age of the patient, the diagnostic delay, and the alteration of the quality of life in patients over 36 years old and those with about 11 years of diagnostic delay presenting the slight alteration. Patients with a high social level had very severe quality impairment. Women on hormonal treatment, those with a history of pregnancy, childbirth, miscarriage and abortion had a slight and significant deterioration in quality of life (p 0.05). Conclusion: Despite some limitations, our preliminary study highlights that in sub-Saharan Africa, the diagnosis of endometriosis is delayed and associated with a severe alteration in quality of life. Moreover, diagnosis of endometriosis seems to be restricted to women with high social levels. Therefore, further efforts are required to develop a health policy to decrease delay for diagnosis with potential benefits on symptoms, quality of life, fertility while limiting stigma and psychological effects of this debilitating pathology.

Management of Tracheal Stenosis in Sub-Saharan Medicalized Context: Real Challenge about Two Clinical Cases

Introduction: Post-intubation tracheal stenosis (STPI) is a complication of ventilatory assistance by intubation and/or tracheotomy. Her frequency is estimated between 10% to 20%. The treatment of choice remains surgery. It is based on tracheal resection-anastomosis which guarantees satisfactory and reliable long-term results. Objectives: To determine the frequency of post-intubation tracheal stenosis, to specify the diagnostic and therapeutic methods, to determine the complications and the evolution. Material and methods: This was a study carried out in the ENT and head and neck surgery department of the University Hospital Center Gabriel TOURE. Our study focused on two (02) cases of post-intubation tracheal stenosis (STPI) collected during a period of 1 year (January 2021 to December 2021). Results: They are all acquired, secondary to an intubation. The two (02) cases benefited from a tracheal anastomosis resection, the indications of which were specified and the results and complications evaluated. Conclusion: Our results show that resection anastomosis remains the reference treatment for STPI.

Noninvasive Respiratory Strategies in Patients with Acute Hypoxemic Respiratory Failure and COVID-19 in Gabon: A Prospective Observational Study

Importance: The best respiratory support technique to reduce intubation and mortality in patients with respiratory failure due to COVID-19 is controversial. Objective: To determine the respiratory support technique that could reduce the need for tracheal intubation and mortality in patients with respiratory failure due to COVID-19 admitted to intensive care units (ICUs) of Military’s Hospital (HIAOBO) in Gabon. Design, Setting, and Participants-Methodology: Prospective observational study over 10 months (January 2021-October 2021). We included patients admitted to intensive care for SARS Cov2 pneumonia who had benefited from available ventilatory support: high concentration face mask, High Flow Nasal cannula (HFNC), NIV (Non Invasive Ventilation), Continuous Positive Airway Pressure (CPAP). The choice was guided by the clinical condition, and the choice of the prescribing physicians. Recourse to mechanical ventilation was decided when faced with a Glasgow score of less than 13, an SpO2/FiO2 ratio ≤ 300, a FR ≥ 35/min, the impossibility of drainage of secretions. Main Outcomes and Measures: The primary outcome was the proportion of patients requiring intubation. The secondary outcomes were mortality in ICU. Results: The sample included 97 patients, the average age was55.6 years, hypertension was the main comorbidity (51.1%). Mean respiratory rate (RR) was 30.8 cycles/min, admission SpO2 was 83%, respiratory alkalosis was present in 63% of patients, mean CT involvement was 51%.Respiratory support was NIV (56.7%), CPAP (21.65%), high concentration face mask (18.55%). Sixteen percent (16%) of patients were intubated, 93% of them following failure of NIV. Mortality was 30%, mechanical ventilation was an independent risk factor for mortality. Conclusions: Non Invasive Ventilation, CPAP, and high-concentration face mask were frequently used in patients with COVID-related acute respiratory failure. The CPAP has reduced the need for intubation. Mechanical ventilation is a risk factor for death.

Uterine Reperfusion Ischemia and Use of Elastic Tourniquet

Introduction: In humans, it has not been established that the use of elastic tourniquet (ET) during myomectomies, whose delivery times do not exceed 90 minutes, which is responsible for ischemia reperfusion (I/R) systemic. Objectives: To study the plasma variations of markers of I/R during myomectomies performed with ET, whose exposure time does not exceed 90 minutes. Population and methods: Plasma créatinin phosphokinase kinase (CPK) and gluthatione peroxydase (GPX) levels of patients with ET myoma (M + G +, n = 19), taken before, during and after exposure, were compared to those of women operated on myoma without tourniquet (M + G -, n = 15), carriers of unoperated myomas (M + G0, n = 20) and controls (M0G0, n = 18). The duration of exposure of the ET was determined, and perioperative variations of GPX, Ca2+, K+ and CPK between M + G + and others groups were analyzed (p Results: The average duration of exposure of the ET was 51.56 ± 14.12 [30 - 88] min. In M + G +, prior to insertion, CPK was 71.64, GPX 3.537, Ca2+ 3.000, K+ 3.934, and did not vary from those of M + G - (CPK = 59.354, GPX = 3.205, Ca2+ = 2.525, K+ = 3.788), M + G0 (CPK = 71.640, GPX = 2.759, Ca2+ = 3.004, K+ = 3.934) and M0G0 (CPK = 57.2, GPX = 2.306, Ca2+ = 2.879, K+ = 3.705). Conversely, during the posture (CPK = 95.665, GPX = 3.645, Ca2+ = 3.642, K+ = 4.757) and after the release of the ET (CPK = 135.443, GPX = 3.694, Ca2+ = 3.892, K+ = 5.322), these rates were higher among the M + G + compared to the M + G0 and M0G0, but did not differ from those of the M + G - during (CPK = 91.270, GPX = 3.413, Ca2+ = 3.068, K+ = 4.257) and after release (CPK = 137.776, GPX = 3.632, Ca2+ = 3.148, K+ = 5.075). Conclusion: The plasmatic concentration of ischemia (CPK, K+) and reperfusion (GPX, Ca2+) biomarkers does not differ between M + G + and M + G -, but is elevated relatively to controls (M0G0), but also to M + G0’s group. These results show that, for exposure times not exceeding 90 minutes, the elastic tourniquet is probably not the cause of the increase in plasma I/R markers observed in M + G + women. Moreover, these data suggest that the variations of the markers observed during the different surgical stages within each of the two groups of women M + G + and M + G - compared to those of the controls (M0G0) and unoperated myomas (M + G0) are due essentially to the surgical act.

Contribution of EFAST Ultrasound in the Management of Chest and Abdomen’s Blunt Trauma in the City of Parakou, Benin

Background: Blunt thoracic and abdominal traumas are frequent and have a poor prognosis in the absence of prompt diagnosis and adequate management. An ultrasound performed in the emergency room allows a precise diagnosis and a better orientation of the victims. Objective: To assess the contribution of EFAST ultrasound in the management of blunt thoracic and abdominal traumas. Patients and method: Cross-sectional descriptive and analytical study with prospective data collection carried out from February 20th to August 20th, 2017 in the emergency and intensive care units of the Parakou University Hospital Centre. An ultrasound machine fitted with a 3.5 MHz convex probe was used to search for post-traumatic effusion by the EFAST technique on admission and then as needed over 24 hours and after surgery. Results: Sixty-three patients were collected with an 85.71% male predominance. The average age was 31.36 ± 13.29 years. The time to perform the EFAST ultrasound was 7 ± 3 min. EFAST was positive in 50.79% of patients. Five patients (7.93%) received emergency treatment for hemodynamic instability and positive EFAST within an average of 3.46 ± 2 hours. Eighteen patients (27.58%) received after monitoring by EFAST, surgery within 9 hours 12 minutes (hemoperitoneum) and 27 hours 58 minutes (hemothorax). Two patients were tested positively for EFAST after surgery. Conclusion: The introduction of an EFAST ultrasound as a sorting tool in an environment with limited resources is desirable and feasible.

Double Invagination Ileo Coeco Colic due to a Carcinoma of the Right Colon about a Case

Colonic intussusception on carcinoma is rare. We report the case of an ileo-coeco-colic invagination on carcinoma of the right colon that occurred in a 40-year-old patient. The clinical symptomatology had a tendency to tumoral pathology of the colon. The ultrasound performed revealed acute intussusception. During the operation, we found an ileoceco-colic intussusception. A right hemicolectomy was performed. Anatomopathological examination of the operative specimen confirmed the diagnosis of adenocarcinoma. Conclusion: Intussusception is uncommon in adults, and is often indicative of an organic barrier to colon. His symptomatology is not very specific. Ultrasound and abdominal computed tomography help in the diagnosis. Surgical excision followed by anatomopathological examination of the operative specimen allows the diagnosis to be made histologically.

Is There a Relationship between Endotheline-1, Vascular Cell Adhesion Molecule-1 and the Arterial Hypotension Observed during Spinal Anesthesia?

Introduction: The involvement of the endothelial dysfunction (ED) in arterial hypotension (AHPT) post of spinal anesthesia (SA) has not been established. Objective: To determine if there is a relationship between ED and AHPT observed during the 1st 15 minutes after SA. Population and Methods: The study concerned 40 people who were to benefit from a programmed herniorrhaphy under SA and 40 controls (SA-). The correlations between mean plasma concentrations of endothelin-1 (CmET-1, pg/ml) and Vascular Cell Adhesion Molecule-1 (CmVCAM-1, pg/ml) taken from SA+ one hour before (H0), then 15 minutes after the SA (H15) and the mean arterial pression (AMP, mmHg) with heart rate (bpm) were analyzed (p < 5%). Results: CmET-1 and CmVCAM-1 of SA- were 1.07 and 3.34, respectively, compared to 1.12 (p = 0.735) and 3.57 (p = 0.862) in SA+ at H0 and H15. In SA+, at H15, CmET-1 was 1.13 (p = 0.823) and CmVCAM-1 was 3.57 (p = 0.257). In SA-, a negative correlation existed between CmET-1 and CmVCAM-1 (r = -0.438;p = 0.005). Conversely, in SA+, whether at H0 (r = -0.31;p = 0.051) or at H15 (r = 0.024;p = 0.883), no correlation existed between CmET-1 and CmVCAM-1, nor between MAP and ED markers (r = 0.111;p = 0.325). Conclusion: These results show that there is no relationship between the AHPT which occurs during the first fifteen minutes post SA, CmVCAM-1 and CmET-1. Moreover, these data suggest that ED is not involved in AHPT post SA.

Diagnostic and Prognostic Interests of Plasmatic Neuroglobin during Stroke in Adult at the Acute Phase

Introduction: Neuroglobin (Ngb) owes its name to its preferred location in the nervous system. Its plasma concentration increases during cerebral ischemia. However, the interest of its dosage in the diagnosis and the prognosis of the strokes in the adult is not defined. Objectives: To determine if plasmatic Ngb can be used as a diagnostic biomarker and prognostic for stroke in adults at the acute phase. Population and Methods: This was a prospective study in 69 people, including 39 suspected stroke (Cerebral ischemia or CI, Intracerebral hemorrhage or ICH) and 30 healthy volunteers (controls). The plasma concentration of Ngb (CmNgb in ng/ml) of the patients was determined at admission day (d1), at the third day (d3) and seventh day (d7). CmNgbtaken at d1 was compared between patients and controls. Its evolution over time, as well as its relation with the clinical parameters, including the Glasgow coma scale and the short-term mortality in stroke subjects was analyzed by the Mann and Whitney tests and the Wilcoxon test (p Results: At d1, the CmNgb of all types of stroke was 3.140 ± 2.700 ng/ml, and did not differ significantly from controls (0.303 ± 0.114 ng/ml, p = 0.070). On the other hand, it was higher in CI victims (5.800 ± 0.720 ng/ml) than in ICH (1.750 ± 0,090 ng/ml) (p = 0.030). It then decreased on d3 in CI victims (2.600 ± 0.112 ng/ml) and ICH (0.420 ± 0.211 ng/ml), returning to normal on d7 (0.420 ± 0.200 ng/ml for CI’s, p = 0.001, and 0.360 ± 0.300 ng/ml for ICH, p = 0.002). There was a relationship between CmNgb, delay of occurrence of the first symptoms of the stroke (3.140 ± 2.700 ng/ml before the 6th hour, and 0.643 ± 0.244 ng/ml after the 6th hour (p = 0.003) and the volume of the hematoma (p = 0.0027). None relationship existed between CmNgb, Glasgow coma scale (p = 0.427) and short-term mortality (CmNgb = 3.95 ng/ml in survivors versus 2.65 ng/ml in deceased p = 0.060). Conclusion: This study shows that the plasma concentration of Neuroglobin is high during stroke in humans in the acute phase. This elevation follows triphasic?kinetics and appears to be more important during infarction than hemorrhage. These results suggest that CmNgb can be used as a diagnostic marker for stroke in adult at the acute phase, by differentiating ischemia from hemorrhage. However, this work needs to be confirmed on a larger sample of patients.

Tonsillitis and Their Complications: Epidemiological, Clinical and Therapeutic Profiles

Tonsillitis or angina, is considered as an inflammation of the palatine tonsils most often of infectious origin. It can be acute or chronic. The germs in question are mostly viruses and bacteria. Objectives: The objective of this work was to study the epidemiological and therapeutic profile of tonsillitis and their complications in the ENT Department and Head and Neck Surgery of the Mother-Child University Hospital in Luxembourg. Patients and Methods: This is a prospective study over a 12-month period from January 2018 to December 2018, including all patients who presented with tonsillitis and/or their complications. Results: Three hundred and fifteen (315) patients were collected during this period. The average age in our study was 14.25 years with extremes ranging from 2 years to 61 years. The sex ratio was 0.65 in favor of the female sex. During this period we recorded 80.95% of cases of uncomplicated tonsillitis including 60.50% for acute tonsillitis, 24.5% for chronic tonsillitis 5% for adenoid tonsillitis and 19.05% for complications. Complications included peritonsillar phlegmon 42.22%, heart disease 33.33%, cervical cellulitis 8.89%, adeno-phlegmon 6.67%, para-pharyngeal abscess 4.44%, and sepsis 4.44%. The exclusive medical treatment was performed in 44.31%. Surgical treatment (drainage incision and tonsillectomy) was performed in 55.69%. Conclusion: Tonsillitis and its complications represent an important pathology in ENT. Feynophagy febrile is the pair-origin symptom that can lead to the diagnosis. The prevention of complications is the guarantor of the reduction of its morbidity. We recommend that in the absence of RDT (Rapid Diagnostic Test), it is necessary to systematize antibiotic therapy to prevent serious complications.

Chronic Purulent Otorrhea in the South of the Sahara: Epidemiological, Clinical and Therapeutic Profiles about 135 Cases

Objective: To study the clinical and therapeutic epidemiological profile of chronic purulent otorrhea in the ENT and CCF departments of the Gabriel Touré university hospital. Materials and Method: This was a retrospective study from May 2019 to April 2021. We made an exhaustive sampling of all patients who consulted for chronic purulent otorrhea with a complete medical file. All ages were included (except from 0 to - 5 years), and all sexes combined. The data medium was the patient records and the department’s operating report register. The non-inclusion criteria were patients with incomplete files and patients who were less than 5 years old. Results: In total, we collected 135 cases. The average age of our patients was 29.27 years. The most represented age group was 16 to 25 years old. We noted a male predominance in 60.7%. The associated signs found were hearing loss, earache, tinnitus, ear pruritus, vertigo, headache and facial paralysis. The main pathology involved is chronic otitis media (CMO) in 55.5%, the most serious of which is dangerous chronic otitis (8.1%). All of our patients have received medical treatment. The treatment was surgical in 64% of patients after medical treatment. With the mean follow-up of 6 months, tinnitus and reperforation were the most common complications found in 6.2% and 3.1% respectively. Conclusion: Chronic purulent otorrhea is the most common ear discharge in ENT consultation. The main pathology involved is CMO, the most formidable of which is cholesteatoma. Medico-surgical treatment.

Pneumothorax in Children: A Study of 47 Pediatric Cases at Mali Hospital 2017-2020

Objectives: Pediatric pneumothorax, whether primary or secondary (infection, trauma, or iatrogenic), is sometimes life-threatening. We tried to determine the clinical characteristics of pediatric pneumothorax in Mali. Materials and Methods: We collected all pediatric patients (0 - 15 years) admitted for pneumothorax in the pediatric department of the Mali Hospital from January 2017 to December 2020. Results: During this period, a total of 5569 children aged 0 - 15 years were hospitalized, of whom 47 had pneumothorax or 0.84%. Children under 5 years of age were the most affected (80%). Dyspnea was the most common reason for hospitalization (95.7%). The causes of pneumothorax were (in order): infectious causes dominated by bullous dystrophies (70.2%), traumatic (25.5%), and iatrogenic (4.2%). Pneumothorax was compressive in 42.6%. The frequency of anemia was 79.3%. Surgical drainage was performed in 87.2% and almost all (97.6%) were treated with amoxicillin/clavulanic acid. The mean duration of hospitalization was 10.06 days (range: 0 - 35 days): 74.5% were cured while 25.5% died. Conclusions: We reconfirmed that pneumothorax is a pediatric emergency. Children under 5 years of age are the most affected. The main etiologies are infectious bronchopneumonia. The prevention and treatment of respiratory infections, the implementation of good bacteriological diagnostic tools, and the use of surgical video-thoracoscopy will reduce its mortality rate.

Deafness: Epidemiological, Clinical and Therapeutic Aspects in 15 Year Olds and over at the University Hospital Center Gabriel Toure of Bamako

Objective: To study the epidemiological, clinical and therapeutic aspects of hearing loss in 15-year-olds and over at the CHU GT of Bamako. Materials and Method: This is a longitudinal prospective study carried out in the ENT department of the University hospital Gabriel Toure in Bamako over 13 months (from September 2018 to September 2019). We carried out an exhaustive sampling of all the patients who consulted in the department for hearing loss and whose deafness was confirmed at pure tone audiometry with age greater than or equal to 15 years. The exclusion criteria were all patients under the age of 15 as well as a hearing loss related to earwax or foreign bodies and refusals to participate in the study. Results: Two hundred and thirty (230) patients were collected during the study. Dominated by the male sex with a sex ratio of 1.5 or 3 men for 2 women, with an average age of 38.16 ± 19 years with extremes ranging from 15 to 86 years. Among our patients, 37.40% had unilateral deafness, progressive installation evolving more than 12 weeks with a rate of cases had headaches 41% and had a history of chronic otitis media (CMO) 27%. There were a few cases of mixed type deafness, 30% had mild deafness, 22% moderate deafness and 40% severe deafness, according to the BIAP classification. Among our patients, 22.16% had conductive hearing loss, and those with sensorineural hearing loss accounted for 15.24%. Conclusion: Pure tone audiometry remains essential in the diagnosis of deafness. It not only makes it possible to confirm or invalidate the deafness, but also to define the type of deafness and especially to classify the deafness according to the degree of the average hearing loss established by the BIAP.

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.