Average Consultation Time Research Articles

Drugs used in patients with heart failure in a tertiary care center – A drug utilization study

Background: Heart failure (HF) patients need multiple drug therapy. There are numerous drugs used worldwide but knowledge regarding pattern of their use is limited from Eastern India. Aims and Objectives: Objective was to assess utilization pattern of drug among the adult patients with HF in Nilratan Sircar Medical College and Hospital, Kolkata, West Bengal. Materials and Methods: This was an observational and cross-sectional study conducted in Department of Pharmacology and Cardiology at NRS Medical College and Hospital. A total 100 adult patients were included for this study after fulfilling inclusion and exclusion criteria and their treatment details were recorded. Results: A total of 670 drugs were prescribed in this study (average of 6.7 drugs per prescription). Most of the patients were between 41 and 60 years of age and most of them were male (61%). Significant percentage of prescriptions were generic (86.87%) and 100% were adequately labeled and dispensed. Average consultation time for each patient was 10.5 min. Commonly used drugs included diuretics, angiotensin converting enzyme inhibitors, beta-blockers, mineral-corticoids receptor antagonists, and angiotensin receptor blockers. Conclusion: This study showed that standard treatment protocol guidelines were followed and rational use of drug was seen.

Antibiotic Prescribing Patterns for Outpatient Pediatrics at a Private Hospital in Abu Dhabi: A Clinical Audit Study.

Antibiotics are commonly used in pediatrics. The aim and objectives were to evaluate the antibiotic prescribing patterns of pediatric outpatients at a private hospital in Abu Dhabi, UAE. A retrospective drug utilization review was conducted for pediatric patients aged 1-18 between June and December 2018. The prescriptions with inclusion criteria were reviewed and evaluated by using the WHO indicators. 419 encounters included were female (50.1%). Most pediatrics were aged 4-6 years (35.3%). The average number of drugs per prescription were 4.9 drugs. The percentage of parenteral medication prescriptions was 16.9%, and with antibiotic prescriptions was 43.0%, where cefaclor was the most prescribed antibiotic (31.1%). The average consultation time was 14 min, while the average dispensing time was 9.6 min. The most common diagnosis where antibiotics were prescribed was acute pharyngitis (33.4%). There were about 60.6% with lab investigation. As per the WHO indicators, the pediatric outpatient department has a high rate of antibiotic use and polypharmacy, but adherence to the drug formulary and prescribing medicines using generic names was appropriate. The average time for consultation and dispensing were suitable. Irrational antibiotic use for inappropriate diagnoses such as acute otitis media and bronchiolitis were found.

Assessment of Drug Use in a Tertiary Hospital in Southeast Nigeria Based on Who Core Drug Use Indicators

Background: Irrational use of medicines is a global phenomenon and an issue of concern with so many undesirable consequences. The complex nature of the pharmaceutical care process is an indication for an essential tool that investigates drug use pattern in health facilities. The WHO released the core drug use indicators to address these issues. The study assessed drug use in a tertiary hospital in southeast Nigeria based on WHO core drug use indicators. Methods: A cross-sectional descriptive study design was used and the study was conducted from October 2021 to June 2022. Retrospectively, 300 prescriptions were selected and reviewed using systematic random sampling for a year from 2020 -2021 to investigate prescribing indicators. A total of 120 randomly selected patients and pharmacy personnel were observed and interviewed to investigate the patient-care and facility-specific indicators. The WHO/INRUD core drug use indicators were used to assess the patterns of drug use in comparison to the result gotten. Results: The average number of drugs per encounter was 2.76, the Percentage of drugs prescribed by generic names was 78.02%, the Percentage of antibiotics prescribed was 33.33%, and the Percentage of injections prescribed was 1.67%. Average consulting time in minutes was 17.5 minutes, the average dispensing time in seconds was 92.1 seconds, the Percentage of drugs actually dispensed was 76.97%, Percentage of adequately labeled was 100%, and the percentage of patients’ knowledge of correct dosage was 90%. The facility did not have an Essential Drug List but had all (100%) the key drugs listed by the WHO drug list. Conclusion: All of the prescribing indicators deviated from the WHO/INRUD recommended optimal values. Patient-care and facility-specific indicators deviated from the optimal values except that of the average consultation time, average dispensing time, percentage of drugs adequately labeled, and 100% availability of key drugs. Although a few of the WHO benchmark for rational drug use were met, the outcomes were not satisfactory and required interventions to improve rational drug use in the facility.

Study of Generalized Peritonitis in Children at the Hospital Fousseyni Daou of Kayes: Mali

Introduction: Peritonitis is an acute inflammation of the peritoneum; it is a surgical emergency in children, as in adults. It is still common in underdeveloped countries because of the delay in diagnosis. There are primary and secondary peritonitis. The main symptom is violent and sudden abdominal pain in children. The objectives were to determine the hospital frequency of peritonitis, to describe the clinical and therapeutic aspects, to evaluate the mortality of peritonitis. This was a retrospective study that took place in the pediatric surgery department from January 2019 to December 2021; using patient records. All patients operated for peritonitis from 0 to 15 years old were included in this study. Results: During this study, we performed 650 surgeries, including 23 cases of peritonitis, or 3.53% of the surgeries. The ages were between 4 and 15 years old, the male sex was predominant, i.e. 65.21%: 15 cases. The average consultation time was 7 days. The clinical signs were dominated by abdominal pain in 100% of cases, asthenia and deterioration in general condition. All the patients had benefited from a biological assessment, the widal was positive in 12 cases. Abdominal X-ray without preparation and abdominopelvic ultrasound were performed in all patients. Abdominal X-ray without preparation objectified 6 cases of pneumoperitoneum, water levels in 10 patients. Ultrasound showed 16 cases of appendicular peritonitis, i.e. 69.56%. All patients underwent laparotomy and we found 16 cases of appendicular peritonitis 69.56%, 5 ileal perforations i.e. 21.73%, 1 perforation of the gallbladder i.e. 4.34% and tuberculous peritonitis confirmed by pathology 4.34%. The postoperative course was simple in 65.21%, parietal suppuration was observed in 21.73% of patients. We had recorded 3 cases of death or 13.04%.

Cancer du rein de l’adulte au Centre Hospitalo-universitaire de Tengandogo : Aspects épidémiologiques, cliniques, histopathologies et thérapeutiques

OBJECTIVE: To study the epidemiological, clinical and histopathological aspects of renal cancers at the University Hospital of Tengandogo. MATERIALS AND METHODS: There were a cross-sectional, descriptive and analytical study with retrospective collection over a period of 5 years and 6 months, from January 1st, 2016 to June 30, 2021. RESULTS: We treated 39 patients, 33 patients were included, with an exhaustiveness of 84.6%. The mean age of the patients was 52.6 years ± 11.7. The sex-ratio was 1.06. Eight patients had risk factors. Lumbar pain and hematuria were the most frequent circumstances of discovery. The average consultation time was 8.6 months ± 1.1. The physical examination had objectified a lumbar mass in 17 patients, 9 patients had lumbar contact and the examination was normal in 13 patients. The right kidney was the most affected side with 17 patients. The mean size of the tumor was 12.2 cm ± 2.4. All patients underwent radical nephrectomy. We recorded one death intraoperatively. The histological type was clear cell renal carcinoma in 32 patients. One patient had chromophobe cell renal cell carcinoma. CONCLUSION: Kidney cancer is a rare pathology, it occurs in adults around the age of fifty. Patients consult late and locally advanced and metastasized forms are the most frequent. The histological type is dominated by clear cell renal carcinoma. KEYWORDS: Cancer; Kidney; Nephrectomy.

Epidemio clinical, anatomopathological profile and iconography of breast cancer in women at the university clinics of Lubumbashi

Introduction: Most cases of breast cancer occur in low-income countries. Breast cancer patients in resource-limited settings experience longer diagnostic delays, leading to later-stage presentations. The late discovery of breast cancer breast exposes the patient to longer treatment mutilating, longer, more expensive, with reduced chance of recovery. It is therefore important to promote early detection and diagnosis at the beginning stage to reduce morbidity and mortality.Patient and Method: our cross-sectional descriptive study was carried out over a period of 5 years (2015-2020) in the surgery department of the university clinics of Lubumbashi. Its main objective was to describe the epidemiological, clinical and histological aspects of breast cancer breast at the University Clinics of Lubumbashi.Results: it emerges from this work that breast cancer represents 3.34% of all cancers collected during the study period. The number of breast cancers varied from 3 cases recorded in 2015 to 29 in 2020, with an average of 12 cases per year. The majority of them came from the Lubumbashi commune, i.e. 39% of cases. The age of the majority of patients was over 35 years old or 60% with an average of 41.59± 13.44 years. The average consultation time was 10.52± 7.12 months, the breast nodule was the revealing sign in most cases, i.e. 94%. The most important primary method of cancer detection was self-examination (59.72%). The most found risk factors were family history and breast density with 36% and 28% respectively. The tumor was located on the left in 65% of cases with the most important seat in the supero-external quadrant (42%). The mean tumor size was 4.43±2.26 cm. The most found histological type was invasive ductal carcinoma with 90% of cases. Management was surgical and consisted of lumpectomy in the majority of cases (58.83%).Conclusion: breast cancer remains very common in Lubumbashi among women over 35 years old. Its diagnosis is often late, the average delay being 10.52±7.12 months. It is important to strengthen early detection measures in order to reduce mortality linked to late management.

Cancer inflammatoire du sein : Aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs. A propos de 43 cas à l’Institut Joliot-Curie de Dakar

OBJECTIVE: To clarify the epidemiological, diagnostic and therapeutic features and to improve the prognosis of inflammatory breast cancer. MATERIALS AND METHODS: This is a retrospective study from January 1, 2018 to December 31, 2020 including patients with a diagnosis of inflammatory breast cancer. RESULTS: During the study, 1.730 cases of breast cancer were collected, of which 43 cases of inflammatory cancer (2.5%). The average age of the patients was 44.8 years. The average consultation time was 6.4 months. All patients had lymph node involvement. Non-specific infiltrating carcinoma was the histological type found in all cases. All patients received at least a first line of chemotherapy with a better clinical response to taxanes than to anthracyclines. Surgery was performed in 69.76% of cases. Forty percent of patients were alive at the end of the study. CONCLUSION: Inflammatory breast cancer is quite rare at the Joliot-Curie Institute. The diagnosis is late. Early diagnostic and therapeutic management would improve the therapeutic outcome of inflammatory breast cancer. KEYWORDS: Inflammatory breast cancer; Epidemiology; Prognosis.

The Role of Virtual Clinics in Postoperative Total Knee Replacement Surgery Follow-Up during COVID-19 Pandemic.

Background The purpose of this study was to evaluate the feasibility of the virtual clinic for outpatient follow-up care after TKR surgery. Methods A total of 546 TKR surgeries were performed from January 2017 to December 2019. 30 patients were not able to go the hospital for routine follow-up. The data collections were taken for age, gender, year of surgery, functional score (Oxford Knee Score (OKS)), and active range of motion (ROM). The virtual clinic was conducted with the physician assistant and the operating surgeon via WhatsApp video call (WhatsApp Inc., Mountain View, California, USA) or Zoom (Zoom Video Communications, Inc., San Jose, California, USA). Result The average follow-up period was 39.1 months. The earliest follow-up was 20 months, while the longest follow-up was 97 months. The average OKS score was 45. The average consultation time for the virtual clinic is 9 minutes 21 seconds. Most of the patients were satisfied with the online consultation, with only two patients having a satisfaction score below 80%. Conclusion The virtual clinic for TKR surgery showed a high satisfaction rate during the COVID-19 pandemic, which has the potential to extend to the postpandemic era.

Epidemiological, clinical and aetiological aspects of otalgia at the Renaissance University Hospital

BackgroundOtalgia is a frequent reason for medical consultation. In Africa, few studies have been devoted to the epidemiology and aetiology of otalgia. To our knowledge, no study has been carried out in Chad.AimsThe objective of this study is to describe the epidemiological, clinical and aetiological aspects of otalgia in Chadian hospitals.MethodsThis was a prospective, descriptive and analytical study conducted at the Renaissance University Hospital from January to August 2020. All the patients that were consulting in the ENT department for otalgia were included. Data was analysed using SPSS version 26. The chi-square test was used to compare the results.Results88 (22.3%) of the 395 patients suffered from otalgia. Their sex ratio was 1:1 (M:F). Their average age was 30.4 ± 19.5 years. The median age was 31.5 years with extremes from 1 to 70 years. Children (1–18 years) represented 30.7% of the cases. The average time of consultation was 27.8 ± 35.0 days. Otalgia was associated with deafness in 33% of the cases and 29.5% of the patients have used cotton swabs. Otogenic otalgia in 73.9% of the cases was significantly more frequent in children (92.6% versus 65.6%, P =0.008). Otogenic otalgia was related to otitis externa, chronic otitis media and Eustachian tube dysfunction in 44.6%, 21.5%, and 13.9% of cases respectively. The aetiologies of the referred otalgias were angina and rhinopharyngitis (30.4%), trigeminal neuralgia (21.7%) and oral cavity, pharyngeal and laryngeal cancer (21.7%).ConclusionOtalgia is a frequent reason for medical consultation at any age regardless of sex. However, ear infections are more frequent in children. Referred otalgias predominate in adults, dominated by pharyngeal infections, trigeminal neuralgia and oral cavity, pharyngeal and laryngeal cancers.

Coverage of External Genitalia and Perineal Defects after the Fournier’s Gangrene

Introduction: We report the experience of the National Center of Burns and Plastic Surgery of Ibn Rochd University Hospital of Casablanca in the coverage of defects secondary to Fournier’s gangrene. Materials and Methods: We retrospectively collected and analyzed clinical, therapeutic, and scalable data of patients referred for perineal coverage after Fournier's gangrene, during a period of 3 years (from January 2018 to December 2020), including age, gender, medical background, Charlson comorbidities index; cause, period of coverage, Performance Status score, the extent of the defect and affected sites, Anesthesia, Surgical technique, and post-operative suites. Results: 46 patients were identified: 43 males (93%) and 3 females (7%); mean age was 53 years. Diabetes was the most common comorbidity (58%). The major cause was proctologic (60.9%). The average consultation time was 44.15 days. The patients presented with defects measuring between 4 cm2 and 800 cm2, mostly affecting the scrotum (80%). Several surgical techniques have been employed and added together, depending on the extent and topography of the defect. 20 were treated by suturing due to sufficient skin laxity, 13 were covered by skin grafting of the penis and/or for an extensive and/or oozing defect. 20 were covered by a scrotal advancement flap for a defect not exceeding half of the scrotum. The fascio-cutaneous flaps, namely the VY advancement flap was performed in 14 patients (uni or bilateral), and the medial thigh flap which was performed in 3 patients, for defects involving the perineum and/or more than half of the scrotum. Seven patients (15.21%) presented coverage technique complications. Conclusion: Adequate coverage of the perineum and external genitalia after the Fournier's gangrene prevents functional sequelae and reduces aesthetic sequelae.

Systematic review and meta-analysis of medicine use studies in Ethiopia using the WHO patient care indicators with an emphasis on the availability of prescribed medicines

ObjectiveTo collate the findings of studies on patient care indicators in Ethiopia using the WHO/International Network for Rational Use of Drugs indicators with a focus on the availability of medicines...

Quadriceps tendon repair using double row suture anchor fixation: Case reports and review of the literature.

IntroductionTraumatic rupture of the quadricipital tendon is rare and disabling. The traditional repair technique involving transpatellar tunnels is still relevant, but this technique seems to be superseded for the technique using anchors. This study aimed to present the place of the anchors in quadriceps tendon tears, and assess the functional results after a means follow-up of 18.66 months.Case reportsWe report 03 cases of acute rupture of the quadricipital tendon collected in the Trauma Surgery and Orthopaedics Department. The average age was 53.66 years, all patients were male, the rupture occurred after a sporting accident in one case, and in 2 cases concerning minimal trauma from a fall in 2 patients followed for renal failure. The average consultation time was 48 h. The right knee was affected in 2. The clinical presentation was identical in all patients with the deficit of active extension of the leg. All patients were treated surgically with the use of double row anchors. The technique used consisted of insertion of two 5.0 mm anchors at the base of the patella, and the proximal part of the quadricipital tendon was sutured with heavy absorbable sutures using Krakow suture.ResultsAt a mean follow-up of 18.66 months, no infectious complications were noted, no active extension deficit and the active flexion average was 123.33°.ConclusionThe rupture of the quadricipital tendon is a rare injury. Surgical treatment by double row anchors gives excellent results with a satisfactory medium-term functional recovery and allow early rehabilitation.

Prostate Cancer in North of Benin: Epidemiological, Diagnostic Aspects and Difficulties of Management

Background: In low incomes country, management and follow up of prostate cancer were hard due to difficult to earn drug and difficult access of new test imaging. We explore the epidemiological and diagnostic aspects of prostate cancer at regional university hospital of Parakou from 1st January 2017 to 1st January 2019. Objective: To study diagnostic and clinical aspects of prostate cancer at regional university hospital of Parakou. Methodology: This study was descriptive with prospective data collection (1st January 2017 to 1st January 2019). Patients who were admitted to the department were included. Demographic, clinical and anatomopathological variables were studied. Result: Eighty-one patients were included; the hospital prevalence is 1.6%. The mean year old of patients was sixty-nine years old ± 10 years old (farthest 45 years old and 95 years old). More than half patients were seventy years old. The medical past history of family cancer were found in 6.1% of cases. The complaints were voiding difficult in 54.3% of cases, urinary frequency in 46.9% of cases, complete urine retention in 28.4% of cases and bones pain in 14.8% of cases. The average time of consultation was 24.3 months (farthest 2 months and 48 months). The mean of prostate specific antigen (PSA) was 93.1 ng/ml (farthest 4 ng/ml and 1000 ng/ml). Adenocarcinoma was found in 84.1% of cases. Classic X-ray imaging was used in most cases to detect metastasis. Five patients had done thoracic-abdominal-pelvis tomography. Sixty-six patients (81.5% of cases) were prostate cancer metastasis. Conclusion: Prostate cancer was frequently disease in seventy years old patients. Diagnostic was late in this study. Awareness campaign of patients for early consult was recommended.

Drug utilization pattern at the cardiac surgical outpatient clinic in a tertiary care hospital at Goa

Background: Drug utilization research encourages rational drug prescribing practices and thus contributes to the contemporary use of drugs in the society. This study assesses the drug utilization pattern (DUP) at the cardiac surgical outpatient department of Goa Medical College hospital. We used the World Health Organization (WHO)-prescribing indicators to analyze the National List of Essential Medicines (NLEM) implementation as recommended in the National Drug Policy. Methods: We used a cross-sectional study design to analyze the DUP. We randomly selected 103 prescriptions dispensed to patients at the cardiac surgical outpatient during the study period. We critically examined these prescriptions for their consistency with WHO core drug use indicators. Results: The average number of drugs prescribed per person was 4.95. The most commonly prescribed top three drugs were antiplatelets (21.46%), beta-blockers (14.76%), and statins (13.78%). Most drugs were prescribed as single drugs (90.98%), whereas 9.02% were fixed-dose drug combinations (FDC). The combination of aspirin and clopidogrel was the most common prescribed FDC. The majority (72.44%) of the drugs prescribed were as per the NLEM 2015 list, whereas the generic name was low (2.8%). We measured Patient-Care Indicators and Facility-Specific Indicators also. The average consultation time and dispensing time were 7.76 and 3.23 min, respectively. The in-house pharmacy dispensed 82% of drugs. 93.75% of the key drugs were available in the facility. A copy of the essential drugs list was readily available in the facility. 96.67% of the patients knew the correct dosage of drugs. Conclusions: Anti-platelets and statins were the most commonly prescribed drugs. There was a high prescribing trend from the NLEM; however, the inclination to prescribe generic names was less. Patient-care and facility-specific indicators were also far from the optimal values except that of the average dispensing time.

Treatment of Neglected Elbow Dislocations by Z-Lengthening of the Triceps Brachii

Introduction: Neglected elbow dislocations are much more common in developing and underdeveloped countries. The main reason for the delay in diagnosis is that patients initially seek treatment from traditional healers. These will immobilize the elbow in extension, which will lead to the retraction of the triceps muscle and collateral ligaments. Patients and Method: We carried out a prospective study over five years (2014-2019). The study involved patients with unreduced elbow dislocation older than 21 days. All patients with a dislocated fracture and those whose x-ray showed joint fusion were not included in the study. We collected 26 patients, 20 men and 6 women with an average age of 27.5 years (17 and 45 years). The average consultation time was 8.9 months (3 - 13). The approach was posterior about 8 cm above the olecranon and 2 cm below the olecranon, the ulnar nerve was identified and isolated. The triceps tendon was cut in a Z from its myotendin junction to the beak of the olecranon, and then lengthened. Results: The patients were reviewed after a mean follow-up of 24 months (12 - 36). The Mayo Clinic’s average elbow performance index was 77.1 (60 - 85), with 19 good and 6 average results. The mean flexion was 114° (100° - 135°) and the mean extension deficit was 31.15° (10° - 55°). The average range of motion was 82.5° (60° - 120°). We did not find a correlation between the duration of the lesion and functional recovery (p > 0.05). The Wilcoxon test showed that surgery significantly improved the overall range of motion of the elbow (p = 0.001). Discussion: Based on this study, open reduction with tendon lengthening should remain a treatment option regardless of the age and chronicity of the dislocation.

The Reception of the User in Gynecological and Obstetrical Consultation of the Nianankoro Fomba Hospital of Segou (Mali)

Introduction: The observation of long queues at the counter and at the consultation had prompted the initiative of this survey whose aim was to assess the quality of reception in order to identify the difficulties of users at the counter and at the gynecology and obstetrics consultation. Methodology: This was a prospective descriptive cross-sectional study that took place in the Obstetrics and Gynecology Department of the Nianankoro Fomba Hospital in Segou from April 15 to May 9, 2019. Recruitment was based on verbal informed consent, availability of clients and respect of anonymity. Results: The study included 68.28% of the users who came to the counter for an outpatient gynecological or obstetrical consultation. The average age of the users was 27.2 years. The average waiting time at the counter was 2 hours and 12 minutes, and the average consultation time was 39.5 minutes. The overall satisfaction rate of the users was 35%. The reasons for dissatisfaction were related to problems encountered by users, including: long waiting times, verbal aggression at the counters, and the unavailability of agents to provide clear information to users. However, it should be noted that 86.7% of dissatisfied users preferred to remain anonymous about the reasons for their dissatisfaction. Conclusion: This study allowed us to take a concrete and objective look at the strengths and weaknesses of the reception of users, and at the same time to obtain basic information to develop a plan to improve the quality of care through reception.

Acute Bowel Obstructions of the Elderly in a Low African Country

Background: Acute bowel obstruction is one of the main causes of non-traumatic gastro—intestinal surgical emergencies. When they occur in elderly patients, they seem to induce higher morbi-mortality. The aim of our study was to identify the causes of these bowel obstructions in elderly patients and to expose the results of their surgical management. Patients and Methods: Retrospective and analytical study of patients aged 65 years and over, operated on between January 2013 and December 2019 for acute bowel obstruction at the University Hospital of Bouake. Demographic, diagnostic, therapeutic and evolutionary data were analysed. Results: The study involved 36 men and 23 women (sex ratio = 1.6). The mean age of these patients was 70 ± 4.6 years (65 and 90 years). A history and/or co-morbidities were found in 67.8% of them. Patients were classified as ASA I (20.3%), ASA II (42.4%), ASA III (33.9%) or ASA IV (3.4%). The average consultation time was 5.3 ± 4.1 days (2 days and 28 days). Bowel obstructions were due to colonic volvulus (38.9%), colonic cancer (22%), postoperative adhesions (18.6%), strangulated groin hernia (16.9%) or internal bowel hernia (3.3%). Volvulated or necrotic bowel and resectable cancers were resected followed by immediate anastomosis or stoma. Near upstream stomas were performed for unresectable cancers. A herniorrhaphy for groin hernias and a mesenteric breach suture for internal hernia were performed after bowel disinterment. Adhesions were released. The time to surgery was 22.3 ± 12.4 hours (2 hours and 72 hours). The post-surgery morbidity was 32.2%, marked by parietal suppurations (47.4%). The post-surgery mortality was 16.9%. Hemodynamic or septic shock, ASA score ≥ III, bowel necrosis and ICU stay were the significant risk factors. Conclusion: Acute bowel obstructions in the elderly are dominated by colonic volvulus. The high mortality is related to various factors highlighting the frailty of the elderly. A multidisciplinary management involving the geriatrician could improve the prognosis.

Become Immediate of Newborns Operated in the Neonatology Department of the Hospital and University Center Gabriel Toure of Bamako (Mali)

Neonatal surgical pathologies in developing countries are characterized by high mortality. The aim of this work was to describe the characteristics of the newborn and its surgical pathologies treated in the neonatal department of the Gabriel Touré University Hospital in Bamako (Mali). Patients and method: This is a retrospective study of 626 files of newborns hospitalized over a period of 3 years (January 2016 to December 2018) for a surgical pathology, whether operated on or not. We have studied the etiological, therapeutic and evolutionary aspects. Results: During the study period, we collected 626 patients who had surgical pathology, i.e. a frequency of 5.35%. The average therapeutic consultation time was 2 days with extremes (1 and 30 days). Pathologies of the abdominal wall and digestive tract represented 57.9% (n = 84) followed by pathologies of the spine 26.9% (n = 39). The mean treatment time was 4.5 days. Twenty-three point sixteen (23.16%) newborns could be operated on. The neonatal mortality rate was 12.4% (n = 18). Mortality was postoperative (100%) with a mean time to onset of 5 days. Abdominal wall pathologies were responsible for 8.7% (n = 13) of deaths. Conclusion: Surgical pathologies of the newborn are characterized by delayed treatment with high mortality. Improving their prognosis requires early diagnosis (prenatal diagnosis) and adequate management.

PRISE EN CHARGE DES URGENCES CHIRURGICALES DIGESTIVES : ETUDE PROSPECTIVE A PROPOS DE 118 CAS

INTRODUCTION Abdominal emergencies are any acute abdominal conditions requiring a quick surgical response. The abdominal emergencies require accurate diagnosis and treatment within a particular time limit to prevent mortality. They constitute a major part of the visceralist surgeon's activity in sub-Saharan Africa. They are still burdened with significant morbidity and mortality. The purpose of this study was to determine the prognostic factors of morbi mortality during the management of non-traumatic abdominal emergencies of the adult. MATERIALS AND METHODS We made a prospective, descriptive and analytical study over 1 year from May 1, 2017 to April 31, 2018 carried out at Saint-Louis regional hospital. All patients, aged at least 16 years old and received in an acute abdominal surgical nontraumatic table were included. Results were analyzed with Epi-Info 7; focused on sociodemographic, clinical, paraclinical, therapeutic and evolutionary data. Findings were significant if the p-value was less than 0,05 RESULTS 118 patients were included in our study, representing 39.5% of digestive surgery procedures. The average age of our patients was 35.9 years with extremes of 16 and 90 years and a standard deviation of 18.1. The sex ratio was 3.9. The average consultation time was 3.5 days. The delay of surgery was 18 hours with extremes of 05h to 10 days. There were 15.3% (n = 18) of comorbidity. Abdominal pain was the most common clinical sign (96.6%). Plain abdominal xray was the most prescribed imaging test (50%) followed by ultrasound (30.8%) and CT (19.2%). Acute bowel obstruction was the most common diagnosis 51 (43.2%) followed by acute peritonitis 33 (28%), appendicitis 23 (19.5%) and strangulated hernias 11 (9.3%). The initial diagnosis tallied at 97.4% with per operative diagnosis. Sigmoid volvulus represented 55% of occlusions, 54.5% of peritonitis was of appendicular origin, and 45.5% of strangulated hernias were inguinal. There were 23 (19.5%) cases of anesthetic incidents. There were 22 hemodynamic instabilities, 4 of which required the use of amines. There were 19 cases of surgical complications, 20.9% of operated patients, dominated by parietal suppuration (15 cases) and postoperative peritonitis (4 cases). Factors influencing this morbidity were: consultation delay (p = 0.02), comorbidity (p = 0.0006), and duration of surgery (p = 0.02). In addition, there was no significant relationship between the delay of intervention and morbidity. The mortality rate was 8.5% (10 cases including 7 occlusions) usually related to septic shock (90%). Mortality was significantly related to age (p = 0.01), consultation delay (p = 0.01), comorbidity (p = 0.00004), diagnosis of acute intestinal obstruction (p = 0.04) and perioperative hemodynamic instability (p = 0.04). CONCLUSION The management of surgical acute abdomens in Saint-Louis remains still intact. Morbidity and mortality factors are dominated by delayed consultation and comorbidity. However, improving the prognosis during adult non-traumatic abdominal emergencies requires consciousness-raising and multidisciplinary. KEYWORDS: morbidity, mortality, acute abdomen, Saint-Louis

CANCERS CUTANES SUR PEAU NOIRE : ASPECTS DIAGNOSTIQUES ET THERAPEUTIQUES AU CHU YALGADO OUEDRAOGO

Summary Objective: To study the clinical, diagnostic and therapeutic aspects of skin cancer at the CHU Yalgado Ouedraogo. Methods: This was a cross-sectional and descriptive study carried out over 9 months, from March 1 to November 30, 2020. The dermatology-venereology, general and digestive surgery departments of CHUYO served as the study framework. All histologically confirmed cases of skin cancer were included. Results: Thirty cases of skin cancer were collected. The mean age of the patients was 48.5 years. The sex ratio was 0.6. The main risk factors were chronic wounds (36.4%) and albinism (27.6%). Housewives and farmers accounted for 73.3% of the patients. The average consultation time was 13.4 months. The average size of the tumor was 9.2 cm. The tumors were ulcerative in 40% of cases. The predominant locations were the lower limbs in 36.7% of cases. Soft tissue ultrasound was performed in 8 patients who presented with swelling. Squamous cell carcinoma was the most common histologic type (40%). An extension assessment was performed in 16 patients. Surgery was the main therapeutic means. It was performed in 22 cases. Resection of the tumor was associated with inguinal dissection in 4 cases. Imatinib 400 mg / day has been used in Darier and Ferrand's dematofibrosarcoma. The dissection was complicated by lymphorrhea in 3 cases. Overall survival was 83%. Conclusion: Skin cancers occur in relatively young patients. Tumor sizes are important. The most common is squamous cell carcinoma. Raising public awareness of skin health problems would reduce diagnostic times and improve prognosis. Keywords: skin cancer, black skin, CHU Yalgado Ouedraogo