Average Consultation Research Articles

Hydrocephalus Surgery in Touba City (Senegal): 0% infection Preliminary study about 20 cases

Introduction: Infection is the most common complication encountered after ventriculoperitoneal shunt. The AIMS of this study is to evaluate the effectiveness of antibiotic therapy with protocol in the prevention of post-operative infections after ventriculoperitoneal shunt in our city. Patients and methods: We retrospectively study 20 hydrocephalus cases in one year. They were operated through the classic VP Shunt insertion technique and with the protocol adopted for shunt implantation. They received antibiotic therapy for ten days. Results: In one year we operated 95 patients,20 (21%) cases were hydrocephalus. There were 7 males et 13 females (ratio:0,53) . The age of patients ranged from 15 days to 12 years and the average age was 13,5 months. The average consultation time was 5,6 weeks. Clinically the most common sign were anterior fontanelle tense (100%) , macrocrania (60%) ,vomiting (80%) and sunset eye sign (80%) . Brain CT-scan was performed in all patient,66% of patients had Transfontanelle Ultrasonography and anyone hadn’t performed MRI. All cases underwent surgical treatment. only ventriculoperitoneal shunt was performed and the standard technique protocol to minimize infection was done during surgery. All of them received ceftriaxone 100mg/kg/day for five days then oral relay by thiamphenicol 50mg/Kg/day for five days. The follow up was good no infection was found (0%). Conclusion: Establishing an aseptic protocol for the shunt is essential to reduce the rate of postoperative infections. This result becomes better when we make a combination of antibiotic therapy and protocol. We can achieve infection rates to zero or less than 1% in case of association

Management of Laryngo-Tracheo-Bronchial foreign bodies in children at the Adolphe SICE General Hospital in Pointe-Noire, Congo

Background: The objectives of our study were to describe the epidemiological, diagnostic, therapeutic and evolutionary aspects of laryngotracheobronchial foreign bodies. Patients and methods: This was a descriptive and retrospective study carried out over a period of 12 years (2007-2019), in the ENT and cervico-facial surgery department of the General Hospital Adolphe SICE of Pointe-Noire (Congo). Results: During this period, we collected 20 files of patients whose age varied from 1 to 10 years with an average age of 5 years who were received for foreign body inhalation. The average age of our patients was 5 years with extremes ranging from 1 to 10 years. A male predominance was noted with a sex ratio of 1.62. The average consultation time was 3 days (2 hours and 30 days), 12 patients (60%) were seen within the first 24 hours. The penetration syndrome was the most common functional sign in 10 cases (50%). The standard cervico-thoracic radiograph was normal in 7 cases (35%). The foreign body was opaque in 10 cases (50%), and in 1 case atelectasis was noted. CT scan was performed in 2 cases (10%). The larynx was the most common location. Indeed, the glottis was affected in 8 cases (61.5%), followed by the supraglottis in 3 cases (23.07%) and the subglottis in 2 cases (15.3%). The plastic toys were found more in the glottis in 6 cases (30%). The evolution after endoscopy was favourable in 17 cases (85%), 2 cases required thoracic surgery, and one death was recorded. Conclusion: Laryngo-tracheo-bronchial foreign bodies are frequent, they pose a public health problem. Their management depends on the strength of the relationship between the ENT surgeon and the anaesthetist. Keywords: Child; Laryngo-Tracheo-Bronchial Foreign Bodies; Endoscopy

Proctologic emergency consultation during COVID-19: Comparative cross-sectional cohort study

IntroductionProctologic issues entail a frequent reason for consultation in the emergency department (ED). We aim to analyze how the SARS-COV-2 pandemic has impacted in the demand for proctological consultations. Material and methodDescriptive comparative retrospective study of cross-sectional cohorts of patients attending the ED for proctological complaints from March to April in 2020 and 2019. Demographic variables, comorbidities, reasons for consultation and diagnosis, treatment and readmission were included. Four periods were analyzed according to the different stages of the pandemic derived limitations. ResultsA total of 191 patients were reviewed, 58 in 2020 and 133 in 2019 with an average age of 48 years (SD 20.1) and 112 (58.6%) males. The average number of daily consultations was 2.18 patients in 2019 versus 0.95 in 2020 (p=0.025) meaning a 56% reduction in consultations for proctological reasons. This difference in average consultations was significant in both periods of lockout (p=0.001) and previous de-escalation (p=0.014). The diagnosis distribution was similar between both periods; however, perianal abscesses doubled their rate in 2020, 22.4% versus 11.3% (p=0.045). There was an increasing need for surgery, 31% vs 15% (p=0.011) with no difference in outpatients regimen after emergency surgery (12.5% vs 7.5%, p=0.201). Three patients in 2020 required readmission to the ED (5.2% vs 12.9%, p=0.086). ConclusionThere was a decrease of a 56% in proctologic emergency consultation, however, the need for surgery was twice more frequent during the study period. Reflection on the use of emergencies for proctological reasons is warranted.

COVID-19 Comorbidity and Non-Communicable Diseases (NCDs) General Reference Hospital (HGR), Niamey, Niger

The COVID-19 infection has highlighted the most vulnerable patients. Indeed, COVID-19 patients suffering from another pathology including NCDs such as Arterial Hypertension (Hypertension), diabetes, cancers and respiratory diseases are paying a heavy price for this pandemic. We undertook a study in Niger to better document this comorbidity in a cross-sectional study that brought together patients hospitalized at the Niamey General Reference Hospital for COVID-19 infection and suffering from one or more NCDs. Among 273 patients hospitalized from March 19 to June 03, 2020, 34.8% had a non-communicable disease associated with COVID-19. The average age of the patients was 55 years (22 years to 94 years) and the sex ratio was 2.64 (72.5 % men and 27.5% women). Hypertension was the most represented NCD with 24.5%, followed by diabetes in 17.9% of cases, respiratory diseases 3.66% and other diseases (Heart disease, Obesity, Dyslipidemia, Gout, Chronic renal failure) with 3%. Health workers were the most affected by the disease with 38.6% of cases. The average consultation time was 3.77 days with extremes ranging from 1 to 8 days. The clinical symptoms characterizing the two main groups of patients (hypertensive and diabetic) were almost identical. It consisted mainly of cough, fever, chills, sore throat and rhinorrhea. According to the WHO clinical criteria for the severity of COVID-19, 34 patients or 16.11% were severe and 177 patients or 83% moderate. The clinical severity of the disease is significantly correlated with the patient's age (over 50 years) and the presence of an NCD associated with COVID-19. A total of 35.8% were hospitalized in intensive care in the NCD and COVID-19 group and 14.6% in the NCD group (p <0.001). The average length of patient hospitalization was 6.87 days overall, it was 7 days in intensive care. In 61.7% of cases the length of hospitalization was greater than 4 days. There was 22.1% in the NCD group and 7.3% in the just COVID-19 group (p <0.001). A total of 90.6% of registered deaths occurred in intensive care.

Management of Posttraumatic Arterioveinous Fistulas of the Limbs in a Sub-Saharan Country

Introduction: Post-traumatic arteriovenous fistulas of the limbs most often occur after trauma but can be iatrogenic since the advent of interventional methods. Materials and methods: This is a retrospective study which took place at the thoracic and cardiovascular surgery department / FANN in Dakar, Senegal over a period from 2006 to 2021. Results: Seven patient files identified were been collected. All were male with an average age of 21 years. The mechanism and the topography of the predominant traumatism being a stabbing attack on the thigh and the average consultation time is 71 days. The limb vessel ultrasound and CT angiography can confirm the diagnosis. All patients underwent open surgery. The outcome was favorable in all patients. Conclusion: Post-traumatic arteriovenous fistulas of the limbs are rare, the diagnosis is clinical and open surgery retains its place in the management.

Investigation and Comparison of Medicine Use in the three Central Referral Hospitals in Sierra Leone

Background: An important goal of National Medicines Policy is to ensure that sufficient quantities of essential medicines are available to health care providers and affordable to patients.Objectives: To investigate and compare the prescribing indicators, patient care indicators and facility indicators in three central referral Hospitals in Sierra Leone.Methods: This was a simple randomized retrospective and prospective study. Three groups were obtained to assess prescribing, patient care and facility indicators in the study sites. About 10% of the prescriptions encountered from January to June 2019, were observed retrospectively. Direct observation of 30 randomly selected patients in each hospital was used to assess patient care. Data collected were organized using Microsoft Excel and analyzed using SPSS version 21. Ethical considerations were observed.Results: The average number of medicines prescribed in the three teaching hospitals (Connaught, PCMH and ODCH) were 4.07, 4.3and 3.3 respectively. Percentage encounter with injections were within standard in PCMT and ODCH. Antibiotics prescribing was slightly higher that WHO recommendation of 30% in all 3 hospitals. Percentage of medicines prescribed by generics were 75.4%, 53% and 77% respectively. The average consultation time was 5.47 minutes while the average dispensing time was 79.7 seconds. Patients that receive their medications at Connaught Hospitals had very little knowledge on how they should take their medicine(s), compared to PCMH and ODCH.Conclusion: This study has shown that irrational use of medicines is a major problem in the three referral hospitals occurring majorly during the prescribing and dispensing processes.

Consultation length, process quality and diagnosis quality of primary care in rural China: A cross-sectional standardized patient study

ObjectiveConsultation length, the time spent between patient and health care provider during a visit, is an essential element in measuring quality of health care patients receive from a primary care facility. However, the linkage between consultation length and process quality and diagnosis quality of primary care is still uncertain. This study aims to examine the role consultation length plays in delivering process quality and diagnosis quality, two central components of overall primary care quality, in rural China. MethodsWe recruited unannounced standardized patients (SPs) to present classic symptoms of angina and tuberculosis in selected healthcare facilities in three provinces of China. The consultation length and primary care quality of SPs were measured and compared with both international and national standards of care. Ordinary Least Squares (OLS) regressions for process quality (continuous dependent variable) and Logistic regressions for diagnosis quality (binary dependent variable) were performed to investigate the relationship between consultation length and primary care quality. ResultsThe average consultation lengths among patients with classic symptoms of angina and those with symptoms of tuberculosis were approximately 4.33 min and 6.28 min, respectively. Providers who spent more time with patients were significantly more likely to complete higher percentage of recommended checklist items of both questions and examinations for angina (β = 1.39, 95%CI 1.01–1.78) and tuberculosis (β = 0.89, 95%CI 0.69–1.08). Further, providers who spent more time with patients were more likely to make correct diagnosis for angina (marginal effect = 0.014, 95%CI 0.002–0.026) and for tuberculosis (marginal effect = 0.013, 95%CI 0.005–0.021). ConclusionsThe average consultation length is extremely short among primary care providers in rural China. The longer consultation leads to both better process and diagnosis quality of primary care. Practice ImplicationsWe recommend primary care providers to increase the length of their communication with patients. To do so, government should implement healthcare reforms to clarify the requirements of affordable and reliable consultation length in medical care services. Moreover, such an experience can also be extended to other developing countries.

Non-traumatic abdominal surgical emergencies at the Communal Medical Center (CMC) of Matam, Conakry

Aim: The aim of the study was to bring the frequency and management of non-traumatic abdominal surgical emergencies back to the Matam communal medical center. Material and methods: This was a retrospective, descriptive three-year study (January 2016 to December 2018) which focused on the files of patients treated in the surgical department of the surgical medical center (CMC). By Matam, for a non-traumatic abdominal surgical emergency. Results: Non-traumatic abdominal surgical emergencies represented 49.98% compared to surgical pathologies. The average age was 31.36% with extremes of 10 and 75 years. A male predominance was noted with a sex ratio = 1.07. The average consultation time was 5.53 days. Abdominal pain was the main reason for consultation. Acute appendicitis and strangulated hernias were the most common and ultrasound was performed in 21 patients (5.05%) and unprepared abdominal x-ray was performed in 49 patients (11.89%). All cases were operated on urgently. The operative consequences were simple in 94.42%. We noted parietal suppurations in 2.18%, postoperative peritonitis in 2.43% of cases and 9 deaths. The mean hospital stay was 7.14 days. Conclusion: non-traumatic abdominal emergencies constitute a public health problem, the prognosis depends on the quality and the precocity of the patient's care.

Radiotherapy of Localized Endometrial Cancer, Experience of The Radiation Oncology Department of The Oncology-Hematology Center of The CHU Mohammed VI of Marrakesh: About 85 Cases

Endometrial cancer is the most common gynecological cancer in developed countries. It mainly concerns postmenopausal women. The objective of our work is to report the experience of the radiotherapy oncology department of the oncology-hematology hospital (HOH) of the Mohammed IV University Hospital of Marrakesh in the management of endometrial cancer. We retrospectively analyzed 85 cases of endometrial cancer treated by radiotherapy (external radiotherapy and /or brachytherapy) in our institution between 2014 and 2019. The data collected from our patients concerned the epidemiological, clinical, therapeutic and evolutionary aspects of this cancer. The median age of the patients was 58 years [37, 82], 88% were postmenopausal. The average consultation time was 08 months. The master symptom was post-menopauseal bleeding in 85% of the patients. Pathological examination showed endometrioid adenocarcinoma in 83% of cases. After workup, 51% of patients were stage I (IA 17%, IB 35%), 25% stage II, 23% stage III (IIIA 3%, IIIB 9% and IIIC 10%) and 1% stage IVA according to the classification of the International Federation of Obstetric Gynecology (FIGO). After surgery, 77% of patients received external beam radiation therapy. The dose delivered was between 46 and 50 Gray (Gy) over a mean spread of 42 days associated with concomitant chemotherapy in 16% of cases. Intravaginal brachytherapy was delivered to 98% of patients. It represented the only adjuvant treatment in 27% of cases, after external radiotherapy in 73% of cases. Adjuvant chemotherapy was received in 36% of patients. After a mean follow-up of 3 years, 82% of patients were still followed in a situation of good control of their disease, 8% of cases of local recurrence and 10% of distant metastasis.

Implementation of biopsychosocial supported self-management for chronic primary oro-facial pain including temporomandibular disorders: A theory, person and evidence-based approach.

Aims of the study were to: Implement supported self-management for chronic primary oro-facial pain in a clinical setting. Evaluate its impact on consultation rates, pain severity, interference with life and patient experience. Sixty-six patients with chronic primary oro-facial pain received the intervention at a facial pain clinic at Leeds Dental Institute, UK. Brief Pain Inventory (BPI) scores measured pain severity and interference with life before and after the intervention. Process mining outlined patient care pathways. Monthly consultation rates measured 12months before and after the intervention were used to evaluate burden on healthcare services and economic impact. Patient feedback was assessed via Patient and Public involvement discussion groups. Mean BPI scores significantly improved after intervention-from 5.70 (SD 1.89) to 3.78 (SD 2.34) (p<.001); mean pain interference score reduced from 19.95 (SD 9.41) to 12.05 (SD 9.64) (p<.001). Average monthly consultations significantly (p=.001) reduced from 0.42/month before the intervention to 0.16/month after the intervention. Economic assessment showed cost savings of £293 per patient per year. Process mining showed high rates of service usage with 31 patients also attending 51 other specialist services between them. Patient and Public Involvement discussion groups with 5 patients identified that the intervention was a 'constant companion' and should be implemented at the outset in the care pathway. Supported self-management for chronic primary oro-facial pain has a positive impact on health outcomes (physical functioning, pain intensity and patient experience), as well as service usage and healthcare costs when implemented in a secondary care clinical setting. Reconfiguring current care pathways to upscale early implementation of such interventions should be a priority for future testing.

Assessment of veterinary drugs dispensing practices in veterinary clinics in Gondar town, North West Ethiopia: a cross sectional study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Dispensing practice plays a major role in the provision of rational drug therapy. This study aimed to assess the veterinary drug dispensing practice by pharmacists and other veterinarian assistance in veterinary clinic Gondar town.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A cross-sectional prospective descriptive study was carried out in the OPD of three public veterinary clinics in Gondar town for three months. The health facility indicators were examined by ensuring the good dispensing practices in three veterinary clinic and availability of essential drug list.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The average consultation time was 13 min and 50 sec. The average dispensing time was 5 min and 3 sec calculated from 100 prescriptions. The percentage of drugs dispensed was 97.50% and percentage of drugs adequately labeled was high from the dispensed drugs (74.4%). The average patients with drug dosage knowledge were very low (25%). The result of the study revealed that the two veterinary clinic health facilities do not have any essential drug list. Out of three, one of them has a key drug from the WHO list 1 (30%) drug was available.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The overall good dispensing practices at three veterinary clinics is low. Training, supportive supervision through continuous medical education, regular up-to-date medicine information and standard treatment guideline, and therapeutic audit are required for improvement of medicine use by prescriber and dispensers.&lt;/p&gt;

Rational Drug Use Evaluation Based on World Health Organization Core Drug Use Indicators in Ethiopia: A Systematic Review.

BackgroundRational use of medicines plays a vital role in avoiding preventable adverse drug effects, maximizing therapeutic outcomes with promoting patient adherence, and minimizing the cost of drug therapy. Irrational use of drugs is often observed in countries with weak health care systems. No review has been done that systematically expresses rational drug use practice based on the three WHO core drug use indicators in Ethiopia. Thus, this study was aimed to review systematically the prescribing, health-facility, and patient-care indicators based on WHO core drug use indicators in Ethiopia.MethodsA systematic article search was conducted in different electronic databases including PubMed/ MEDLINE, the Cochrane Library, EMBASE, Web of Science, POPLINE, the Global Health, and Google scholar. Quality assessment was conducted using Newcastle-Ottawa quality assessment scale. Studies were synthesized and grouped in to prescribing, patient care and health facility indicators.ResultsFrom a total of 6239 articles, 21 studies were found suitable for the review. The highest average number of drugs per encounter was 2.5 while the lowest was 0.98. The percentage of generic drug use was ranged from 70.5% to 100%. The highest percentage of encounters with an antibiotic was 85%. The lowest percentage of drugs prescribed from essential drugs list was 81.4%. The highest percentage of drugs actually dispensed and adequately labeled was 96.16% and 96.25%, respectively.ConclusionThis study showed that the practice of rational drug use varied across region of the country. The average number of drugs per prescription, percentage of drugs encounter with antibiotics, drugs prescribed by their generic name, average consultation time, average dispensing time, percentage of drugs adequately labeled, and availability of essential drugs showed deviation from the standard recommended by WHO. Thus, provision of regular training for prescribers and pharmacists, and ensuring the availability of essential drugs should be encouraged.

Indications and outcomes of the percutaneous nephrostomy at Urology-Andrology Teaching Hospital of CNHU-HKM in Cotonou

Background: The percutaneous nephrostomy constitutes a backup remedy allowing the derivation of urine and thus cancelling the emergency, while waiting for adequate etiological treatment. The objective of this study was to determine indications and outcomes of the percutaneous nephrostomy at Urology-Andrology Teaching Hospital of the National Centre Academic Hospital Hubert KOUTOUKOU MAGA (CNHU-HKM) of Cotonou. Methods: It was a retrospective study carried out from January 1st, 2016 to May 30, 2020. Results: The placement of nephrostomy tubes has been indicated in 15.26% of urine derivations for the obstruction of the upper urinary tract. The average age of patients was 54.85 years with extremes of 28 and 70 years. The two sexes are interested in the same proportion, 10 cases for each. The average consultation time is 31.4 days with the extremes of 5 and 90 days. The obstruction was bilateral in 19 cases on 20. The gynaecological cancers were majority with 9 cases follow-up of those of the colon (4 cases), of the bladder (3 cases) and of the prostate (3 cases). The drainage was unilateral in 18 cases out of 20. The mean blood creatinine rate is 145.52 mg/l with extremes of 10 and 436 mg/l. Blood creatinine rate was pathological in 19 of our patients; it has been ameliorated among patients having an elevated initial creatinine blood level but without reaching normal values in 18 out of 19 patients. The lowest rates of creatinine blood level have been reached after 10.33 days with extremes of 2 and 23 days. After the percutaneous nephrostomy, the surgical abstention has been decided in 13 cases, the dialysis had been done in 5 cases, the reimplantation + installation of the probe double J in 1 case and the chemotherapy in 1 case. The main reason of death of the patients having undergone the nephrostomy was the ionic disorders (13 cases out of 18) mainly the hyperkalemia and the hyponatremia followed of anemia (3 cases out of 18) and of the uremic coma (2 cases out of 18). The middle duration of hospitalization after the drainage was of 16.85 days, with extremes of 1 and 50 days. The death occurred at 18 out of 20 patients and the middle period of survival was 31.25 days with extremes of 1 to 60 days. Conclusion: The percutaneous nephrostomy remains the beneficial alternative for the derivation of the upper urinary tract instead of the double J installation. Popularization of percutaneous nephrostomy would reduce the morbidity and mortality linked to complications of obstructive syndrome of the upper urinary tract; hence the need for awareness for early urological consultation

L'ISCHEMIE MESENTERIQUE AIGUË : PRISE EN CHARGE EN CHIRURGIE GENERALE AU CHU GABRIEL TOURE, AU MALI

Objective: to determine the frequency of acute mesenteric ischemia, to describe the diagnostic and therapeutic aspects and to analyze the results of treatment. Methodology: this was a retrospective and descriptive study conducted from January 2010 to December 2019, in the surgical department of the CHU Gabriel Touré in Bamako. were included all patients admitted for acute mesenteric ischemia, confirmed by CT-scan and / or intraoperatively. Results: in 10 years, 26 cases were collected representing 1.1% of abdominal surgical emergencies. The average age was 54 years and the sex ratio 0.85. The main risk factors were: acute arterial hypertension (11 cases), dyslipidemia (9 cases), oral contraceptive (9 cases), obesity (8 cases). The average consultation delay was 2.6 days. The main clinical signs were: abdominal pain (100%), vomiting (53.8%), gastrointestinal bleeding (38.4%), fever (76.92%), tachycardia (61.53%), hypotension (46, 15%), abdominal contracture (46.15%), abdominal distension (26.92%). The preoperative diagnosis was acute bowel obstruction in 61.5%, acute peritonitis in 34.6%. A midline laparotomy was performed in all patients. Intestinal necrosis was found in all cases, requiring extensive intestinal resection. The immediate operative consequences were simple in 30%; sepsis was observed in 66.67% and multiple organ failure in 33.33%. The mortality was 69.23%. Conclusion: acute mesenteric ischemia is a serious condition discovered intraoperatively, most often in the stage of intestinal necrosis. Early treatment could improve the prognosis. Keywords: Acute mesenteric ischemia, surgery, Emergency, Mali

Diagnostic, Therapeutic and Evolutionary Peculiarities of Spinal Trauma in Children in Sub-Saharan Africa: Experience of Senegal

Introduction: Spinal trauma in children is rare, accounting for 1 and 10% of all spinal traumas. They constitute an entity in their own right due to the injuries they cause. Difficulties (diagnostic) and modalities (therapeutic), different from those of adults the growth of children. The lack of studies in Sub-Saharan Africa leads us to carry out this study focused on the traumatic spine of the child. Patients and Methods: Over a period of 8 and a half years from January 2012 to June 2020, we retrospectively studied 44 cases involving 4 Senegalese hospitals, 3 of which were in the capital and 1 in the province, including children up to the age of 16 who had suffered spinal trauma. Results: Forty-four children were retained, a frequency of 7.11%, with an average age of 10.5 years; sex ratio: 1.6. The most frequent aetiologies were: falls (from trees, from buildings): 41%; play accidents and accidents on public roads: 20.4% each. The average consultation time was 31.3 days. 34% of the patients were ASIA E patients. The majority of patients had performed a spine CT scan as an imaging examination, i.e. 95.4%. The most common site of injury was cervical with 61.3%. The most frequent lesions were: fractures, fracture-luxations and dislocations with 27.3%, 25% and 25% respectively. Five patients had associated lesions, i.e. 11.3% (4 head traumas, 9.1% and 1 pelvic trauma, 1.9). Most of the treatment was surgical (43% orthopaedic, 38.6%) and functional (16%). The post-therapy neurological evaluation (ASIA - backward step) was: A: 25%; B: 2.3%; C: 7%; D: 13.7%; E: 52.3%. We noted 3 deaths and 4 patients were re-operated. There were no consolidation complications such as pseudoarthrosis. Conclusion: Trauma to the spine in children, like any bone trauma, responds well to orthopaedic treatment. Deaths are often related to upper cervical spine injuries or occur in the context of polytrauma. Follow-up should be carried out over several years to detect possible complications at an early stage. Delays in treatment due to the difficulties of punctual medicalised transport remain the challenge to be met in our environment.

How many general practice consultations occur in Ireland annually? Cross-sectional data from a survey of general practices

BackgroundGeneral practice plays a central role in the Irish health system. This study aimed to determine a baseline estimate of the number of consultations completed in general practice in Ireland annually to facilitate evidence-based healthcare planning.MethodsA survey was emailed to all 3378 individual members of the Irish College of General Practitioners in February 2020 asking each practice to report on consultations by general practitioners and practice nurses occurring on the previous day of practice.ResultsA total of 507 practices responded to the survey, reporting 34,594 general practitioner consultations and 13,161 nurse consultations on one day. Extrapolating this figure nationally, we estimate 21,353,731 GP consultations and 7,749,615 practice nurse consultations occur in Ireland annually. An Irish person visits their GP an estimated 4.34 times a year and the average consultation time is 13.7 min.ConclusionsThis study shows that over 29.1 million consultations take place in Irish general practice every year. Innovative interventions to increase the capacity of general practice are needed to ensure high-quality care continues to be accessible in Ireland.

Epidemiological and Anatomopathological Characteristics of Breast Tumors in Young Women in Cotonou in the Republic of Benin from 2015 to 2019

<i>Objective</i>: Study the epidemiological and anatomopathological characteristics of breast tumors of young woman. <i>Patients and Methods</i>: This was a retrospective and evaluative cross-sectional study of patients treated for a breast tumor between January 1, 2015 and December 31, 2019 in two hospitals in Cotonou. All the complete files of patients under the age of 40 treated for breast tumors of whatever nature were listed. The patients were recalled for clinical and / or radiological evaluation. The epidemiological and histological characteristics of breast tumors were analyzed. <i>Results</i>: The study involved 231 breast tumors including 12 cancers (5.2%) and 219 benign tumors (94.8%). The mean age of the patients was 25.7 years±7.2. Self-examination was the most common discovery (81%). The average consultation time was 6.4 months. The right breast and the upper-external quadrant were the most affected in 53% and 31.1%, respectively. Fibroadenomas (70.7%) and invasive ductal carcinomas (9/12) were the most frequent. Obesity and a family history of breast cancer were associated with the occurrence of breast cancer in young women (p ≤ 5%). The relative risk of developing breast cancer was practically zero before the age of 30. Benign breast tumors spontaneously regressed in part or in whole in 35.3% of cases (n=55), they were stable in 44.8% of cases (n=70) and increased in volume in 19.8% of cases (n=31). The age of diagnosis strongly influenced the evolution of tumors in the young woman in Cotonou (p=0.02). In 56% of cases, breast tumors diagnosed before the age of 20 spontaneously resolved in part and in whole. The breast cancer case fatality in women under 40 was 11.1%. <i>Conclusion</i>: Breast tumors in young women are mostly benign. More than half of these tumors diagnosed before the age of 20 resolve spontaneously. The risk of breast cancer is virtually zero before the age of 30 in our series.

Management of Priapism in Sickle Cell Patients: Experience of the Urology Department of the University Hospital Centre of Libreville

Introduction: Priapism is a rare pathology, known since antiquity. Sickle cell disease is the main aetiology in Africa. The aim of our work was to report our experience in its treatment. Material and Methods: This is a prospective, descriptive study carried out at the urology department of the Libreville University Hospital from January 2018 to December 2020. All sickle cell patients admitted to urology for priapism were included. The parameters studied were socio-demographic, clinical and therapeutic parameters as well as the evolution after treatment. Result: We collected 19 priapisms in sickle cell patients. The average age was 20.9 years with extremes of 4 and 53 years. Fifteen patients were homozygous SS. All patients had stasis priapism. The average consultation time was 22.4 hours. All patients had perioperative medical management combining hyperhydration, analgesia and antibiotic prophylaxis. A vasoactive drug was administered to 13 patients. Sixteen patients had a puncture of the corpus cavernosum. A distal cavernosal-spongiosum shunt under penile block was performed in 6 patients. The outcome was favorable from the outset in 12 cases, marked by complete detumescence of the corpus cavernosum. Partial detumescence was noted in 7 patients with the need for a new puncture of the cavernous body. A complication such as edema of the penis was in only one of our patients. A recurrence was noted in 2 patients. After an average follow-up of 6 months, no sequelae erectile dysfunction was observed. Conclusion: Priapism is a frequent complication among sickle cell patients in Libreville. Medical management associated with a cavernous puncture with administration of vasoactive drugs allows a favourable evolution without after-effects.

Epidemiological, Clinical and Therapeutic Profiles of Ophthalmological Complications of Rhino-Sinusitis in a Tertiary Facility in Black Africa

Introduction: Rhinosinusitis is one of the most common ENT diseases. Its main complications are of three types: cranial, endo-cranial and ophthalmological. The aim of this study was to contribute to the study of ophthalmological complications of rhino-sinusitis in our context. Material and Methods: This was a prospective study, of descriptive type, of six (6) months (July-December 2017), concerning the patients received and treated for ophthalmological complications of rhino-sinusitis at the National IgnaceDeen Hospital. Results: During our study period, we collected 32 ophthalmological complications of rhinosinusitis, i.e. 65.31% of cases. The average age of our patients was 34.25 ± 15.15 years with extremes of 8 and 76 years and a sex ratio of 0.45. A history of rhinitis and/or rhino-sinusitis was reported in all our patients. Housewives were the most affected socio-professional group, accounting for 34.37% of cases. The average consultation time was 20 ± 52 days. Tearing, palpebral oedema and purulent rhinorrhea were present in all our patients. Preseptal cellulitis and abscess were the most common complications, accounting for 56.25% and 28.12% of cases respectively. The treatment was medical-surgical. Drainage of a subperiosteal abscess of the ethmoid involved 53.12% of cases. Surgical treatment of the maxillary sinus and/or ethmoid by endoscopy was sometimes associated. The evolution was favourable in all cases. Conclusion: Ophthalmological complications of rhino-sinusitis are still frequent in our developing countries. Their management must be multidisciplinary.

Clinico-Pathological Profile of Malignant Abdominal Tumors in Children: Experience of the Pediatric Oncology Unit in Bamako

Introduction: the objective was to describe the epidemiological and histological aspects of malignant abdominal tumors in children. Methodology: This was a descriptive, cross-sectional study conducted from January 1, 2017 to December 31, 2018. We included all patients aged 0 to 15 years with histologically confirmed abdominal malignancies. Results: We collected 46 files of malignant tumors of the abdomen (35% of pediatric cancers). The majority of patients were under 5 years old (65%). The sex ratio was 1.7. They were generally from disadvantaged socio-economic backgrounds (67%). The average consultation time was 50 days. The main reasons for consultation were abdominal mass (48%), pain (17%) or distension (9%). The mass was large, hard (89%), immobile (71%) and painful (46%). Malnutrition was found in 80% of patients. The mass was retro-peritoneal in 63% of cases and renal in 54%. It was solid in 94% of cases and heterogeneous in 76% of cases. The assay for tumor markers was not performed. Anemia was present in all patients. Fine needle aspiration was performed in 43%, biopsy in 37% and myelogram in 15% of cases. spinal cord involvement was observed in 28% of Burkitt’s cases. The main cancers diagnosed were nephroblastoma (52%), Burkitt’s lymphoma (26%) and neuroblastoma (13%). Stage 1 and stage 2 were frequent in 20% and 22% of cases, respectively; 36% of cases were not staged. The average duration of chemotherapy was 11 weeks. Total resection was performed in 30% of cases. The outcome of the patients was marked by total remission in 65%. Conclusion: Abdominal malignancies are very common in children. The diagnosis of certainty is late in our context.