Regional Hospital Center Research Articles

Epidemiological Characteristics of 64 Covid-19 Patients in Errachidia Province (Darâa-Tafilalet region), Morocco: A Retrospective Analysis

At the time of writing this paper, no data was available for the clinical and epidemiological characteristics of African patients with COVID-19. Herein, we profiled retrospectively the epidemiological characteristics (clinical, laboratory, radiological, treatment, and clinical outcomes) of 64 confirmed cases of COVID-19 in the Regional Hospital Center (RHC) of Errachidia in Morocco. The aim of this study was to analyze the epidemiological characteristics and laboratory Findings of Covid-19 patients in Errachidia Province, Morocco. This is a retrospective single-center study that included all COVID-19 confirmed patients (died or discharged) hospitalized in the Regional Center of Errachidia, Morocco, between March 20, 2020 and May 23, 2020. Patients were confirmed by real-time RT-PCR and epidemiological, demographic, clinical, laboratory, treatment, and outcomes of patients were extracted manually from patient's medical records. In a total of 64 patients with COVID-19, 60.9% of patients were men, with a mean age of 41.5 years (SD 18.62). At the admission, 38 patients were asymptomatic (59.4%), and 58 (90.6%) were clinically classified as being in a benign state. Chronic illnesses were the most comorbidities observed, including diabetes with 8 cases (12.5%), hypertension 3 cases (4.7%), and hyperlipidemia 1 patient (1.6%). The main symptoms were cough 15 (23.4%), fever 10 (15.6), diarrhea 8 (12.5%), headache 5 (7.8%), and sore throat 5 (7.8%). Only 7 patients (10.9%) had lung lesions, and lymphopenia was present in only 7 patients (11.1%). The median duration of viral shedding was 14.5 days (9-22). Concerning deceased cases, they were elderly subjects aged 69.75 years, and they have presented dyspnea, breathing problems, and respiratory distress as specific symptoms. In addition, an increase of the medians of serum AST, CRP, and glucose levels was noticed in this group. During hospitalization, they presented acute respiratory distress syndrome (ARDS), and they were transferred to intensive care before they died. This study revealed that covid-19 infection often appeared in a benign form in the studied population (90.6% in this study). This finding may incriminate the implication of some protective parameters such as genetic, nutritional or other factors in the Moroccan population.

Evaluation of Waiting Times for Patients at the Surgical Emergency Reception Service of the Regional Hospital Center (RHC) of Maradi

Evaluation of Waiting Times for Patients at the Surgical Emergency Reception Service of the Regional Hospital Center (RHC) of Maradi

Which Management for Gunshot Chest Wounds in a War Zone Hospital?

Introduction: Gunshot chest wounds are a life-threatening surgical emergency without immediate management. Method: The study period is two years, covering cases admitted from June 2017 to May 2019. The surgical service of the regional hospital center (CHR) of Diffa in Niger is one of the main second-level referral structures where victims of the armed conflict that started in 2014 in the Lake Chad basin are referred and treated. Through this study, we report the preliminary results of the hospital management gunshot chest. Results: Firearm-related chest wounds accounted for 9.22% of firearm injury admissions, interesting especially young man subjects. Penetrating thoracic lesions involved 14 patients, 12 of whom had high and medium-abundant effusion treated by thoracic drainage. Two patients had a pulmonary contusion and a fatal tamponade pattern respectively. Conclusion: Emergency chest drainage is a first-line saving procedure in the treatment of thoracic wounds with firearms in armed conflict.

Study of the Active Management of the Third Stage of Labor (AMTSL) in Four Maternity Hospitals in the Commune of Kara (Togo)

Introduction: Active management of the third period of labor (AMTSL) significantly prevents postpartum hemorrhage onset. Objective: To assess the practice of AMTSL in four maternity in the commune of Kara (Kara University Hospital Center, Kara Tomde Regional Hospital Center, SOS Kara Mother-Child Hospital, and Adabawere Peripheral Care Unit). Method: This was a cross-sectional descriptive study over four months, from January 28 to May 28, 2019. Two questionnaires were used for data collection: an observation and evaluation grid AMTSL practice and a questionnaire for providers. The grid was designed and adapted to the RPC repository model for emergency obstetric and neonatal care in Africa 2018. The data was processed using the Epi Info 7 software. Results: During the study period, 528 parturients were identified and 30 providers surveyed. No provider had received ongoing training in AMTSL. The practice of AMTSL was systematic at each delivery. The practice was correct in 45.8%. Factors associated with incorrect practice were relationship between caregiver-patient (p = 0.0005), placental examination (p = 0.0003), postpartum monitoring (p = 0.0001). Conclusion and Suggestion: The practice of AMTSL is systematic, but it was incorrect regardless of the provider’s qualification. Continuing education on AMTSL is necessary to prevent postpartum hemorrhage.

Clinical and Therapeutic Profile and Outcomes of Patients with Tuberculosis at the Regional Hospital of Tahoua, Republic of the Niger

This study aims to describe the epidemiological, clinical, therapeutic characteristics of patients followed for tuberculosis at the Regional Hospital Center of Tahoua (Niger) as well as their outcomes.We conducted a retrospective and descriptive study from the medical records of patients followed for tuberculosis between January 1, 2017 and December 31, 2019. A total of 465 patients were included in the present study (304 men and 161 women; mean age: 30 years). Patients coming from urban areas represented 51% of the cases. Bacteriologically confirmed pulmonary tuberculosis represented 63% of the cases, 15% of clinically diagnosed pulmonary tuberculosis and 22% of extrapulmonary tuberculosis including Pott's disease. The HIV testing rate was 97.8%. Tuberculosis-HIV association represented 13% of the cases. The therapeutic success was 90.5%. The lethality rate was 5.2% (24/465). Among 24 patients who died, three had tuberculosis-HIV association.

Epidemiology of Gardnerella vaginalis Infections at Thies Regional Hospital Center (Senegal)

Epidemiology of Gardnerella vaginalis Infections at Thies Regional Hospital Center (Senegal)

Bupivacaine-Fentanyl vs Ropivacaine-Fentanyl: Evaluation of two Spinal Anesthesia Protocols for Emergency Cesarean Section

Objective: Evaluation of the hemodynamic, respiratory and fetal side effects of two protocols for spinal anesthesia (P1: bupivacaine-fentanyl; P2: ropivacaine-fentanyl).
 Material and Method: Prospective pseudo-randomized study comparing two spinal anesthesia protocols for emergency cesarean section conducted in the operating room of the regional hospital center of Saint Louis in Senegal. Study duration was 4 months. We studied, age, indication for Caesarean section, medical and surgical history, P1 and P2 protocols, hypotension, bradycardia, Apgar scores at birth and at 5min. Univariate and bivariate analysis was performed on the R software.
 Result: A total of 115 patients were collected, with a mean age of 27.1 years (E: 15 - 45) and a standard deviation of 7.6. Indications for Caesarean section were maternal and fetal dystocia for 67 patients (58%), fetal distress for 39 parturients (34%), and pre-eclampsia for 5 patients (4%). The P1-Bupi spinal protocol was used in 42 patients (36.5%) and the P2-Ropi spinal protocol was used in 73 patients (63.5%). Anesthetic complications such as low blood pressure, bradycardia and desaturation were found in a total of 30 patients, i.e. in 26% of cases. The mean Apgar score at birth for newborns from the P1-Bupi protocol was 8 (Extremes: 7, 9); the mean Apgar score at birth for newborns from the P2-Ropi protocol was 7.5 (Extremes: 2, 10). There was a significantly negative correlation between the P1-bupi protocol and the appearance of hypotension with p-value: 0.04 and a significantly positive correlation between the P2-ropi protocol and the appearance of hypotension with p-value: 0.04.
 Discussion/ Conclusion: Ropivacaine certainly has a better cardiovascular and neurological tolerance and a better efficacy in terms of analgesia. However, during caesarean sections, it is important to consider the risk of hypotension and possible fetal complications related to its use.
 Keywords: Ropivacaine - Bupivacaine - Spinal anesthesia - Caesarean section

The number of obstructive colorectal cancers in Japan has increased during the COVID-19 pandemic: A retrospective single-center cohort study

BackgroundThe global pandemic of COVID-19 has changed cancer treatment environments. In Japan, cancer screenings were halted and the numbers of endoscopies and surgeries were restricted in some hospitals based on the state of emergency declared. Herein, we investigated the impact of the COVID-19 pandemic on the characteristics of colorectal cancer (CRC) patients in facilities that are on the frontline of both COVID-19 and cancer treatments. Patients and methodsWe retrospectively analyzed the cases of all of the CRC patients (n = 123) who underwent surgery at our regional cancer treatment center and tertiary emergency hospital in Japan during a 120-day period ranging from before to after the state of emergency declaration. CRC patients during the corresponding period in the previous year were also examined. ResultsAlthough the number of CRC patients did not show a significant change related to the pandemic, the incidence of obstructive CRCs significantly increased after the pandemic's start. The numbers of outpatients and colonoscopies both decreased, which could have resulted in the decrease of CRC patients detected by cancer screening during the pandemic. The numbers of symptomatic CRC patients and emergency admissions both increased significantly during the pandemic. ConclusionOur findings indicate the possibility that the discovery of CRCs in patients could be delayed due to the halt in screenings caused by the COVID-19 pandemic, resulting in the increase of obstructive CRCs. These results highlight the importance of cancer screening and suggest that the screening system for cancers should be reorganized before future pandemics.

Prevalence and Management of Snake Bite Envenomation at the Regional Hospital Center of Sokodé (Togo)

Snakebite envenomation (SBE) is a public health issue in Africa, unfortunately neglected and underestimated. SBE is a medical emergency that can be devastating and lifethreatening. A retrospective study was performed from January 1, 2016 to December 31, 2016 in the general medicine department of the Regional Hospital Center (CHR), Sokodé. We included 91 SBE accounting for 5.7% of the whole hospitalizations in the general medicine department at the CHR of Sokodé. The median age of the patients was 34 [23.5-42] with male predominance (59%). Farming activities (75%) and walking (24%) were the most frequent activities when SBE happened, and they occurred mostly in rural areas (80%) during the dry season (56%). Echis genus (37%) belonging to the Viperidae family was the king of snake most often identified. Hospital admission time after a bite often exceeded 24 hours (44%). Clinical manifestations resulted in 76 cases of viper syndrome (83%) and 7 cases of dry bites (8%). Antivenom was administered in 84 cases (92%) within 12 hours (54%) after the bite with a minimum dose of 20 mL (43%). Observed complications were severe anemia (19 cases) and diffuse hemorrhage (32 cases). Case fatality rate was 9%. Antivenom is critical in cases of obvious SBE. High cost and poor access of antivenom, in addition to delayed care due to traditional treatment seeking behavior, are factors of poor prognosis.

Forecasting emergency department overcrowding: A deep learning framework.

As the demand for medical cares has considerably expanded, the issue of managing patient flow in hospitals and especially in emergency departments (EDs) is certainly a key issue to be carefully mitigated. This can lead to overcrowding and the degradation of the quality of the provided medical services. Thus, the accurate modeling and forecasting of ED visits are critical for efficiently managing the overcrowding problems and enable appropriate optimization of the available resources. This paper proposed an effective method to forecast daily and hourly visits at an ED using Variational AutoEncoder (VAE) algorithm. Indeed, the VAE model as a deep learning-based model has gained special attention in features extraction and modeling due to its distribution-free assumptions and superior nonlinear approximation. Two types of forecasting were conducted: one- and multi-step-ahead forecasting. To the best of our knowledge, this is the first time that the VAE is investigated to improve forecasting of patient arrivals time-series data. Data sets from the pediatric emergency department at Lille regional hospital center, France, are employed to evaluate the forecasting performance of the introduced method. The VAE model was evaluated and compared with seven methods namely Recurrent Neural Network (RNN), Long short-term memory (LSTM), Bidirectional LSTM (BiLSTM), Convolutional LSTM Network (ConvLSTM), restricted Boltzmann machine (RBM), Gated recurrent units (GRUs), and convolutional neural network (CNN). The results clearly show the promising performance of these deep learning models in forecasting ED visits and emphasize the better performance of the VAE in comparison to the other models.

The University of Vermont Larner College of Medicine.

The University of Vermont Larner College of Medicine.

Factores que afectan el proceso de toma de decisiones médicas en salas de emergencia de hospitales

Introducción: Durante el proceso de la toma de decisiones pueden ocurrir errores médicos, esto se observa en ambientes de alta presión, principalmente los que cursan con una mayor responsabilidad a la salud humana. El problema de los errores médicos por problemas en la toma de decisiones se encuentra asociados a una alta carga laboral, corto tiempo para la realización de las actividades inherentes al trabajo, falta de dominio del área de trabajo, comunicación inadecuada y cooperación en equipo deficiente o inexistente, llevando a niveles subóptimos en la toma de decisiones.
 Objetivo. Identificar los factores que intervienen en la toma de decisiones por parte del personal médico que trabajan en el área de emergencias en hospitales de segundo nivel de atención en 2 provincias de la zona centro del Ecuador.
 Materiales y Métodos: Se presenta un estudio cualitativo, observacional, descriptivo. Se realizan entrevistas a personal médico que trabaja en áreas de emergencia de la zona centro del Ecuador. Total, de participantes 40 profesionales de la salud (médicos).
 Resultados: Un total de 40 encuestados fueron incluidos en el estudio; se realizó un registro de datos sociodemográficos en las encuestas. La edad media de los participantes fue de 29,8 años con una DE = 29,8 ± 4,35. Los médicos que se encuentran laborando en salas de emergencia en un 75% son profesionales jóvenes con 1 a 4 años de experiencia dentro de la profesión, trabajan turnos de 24 horas, con una atención en promedio de 90 pacientes por guardia, llegando en algunos casos 10% de los encuestados a prestar atención hasta 120 pacientes. Las horas de descanso dentro de la guardia están en un promedio de 4 horas en 24 horas. Todos los encuestados concuerdan con indicar que el trabajo en área de emergencia puede ser más demandante que el trabajo en cualquier otra área del hospital no solo por la cantidad de pacientes, la diversidad y complejidad de las patologías que se atienden lo cual incide directamente en el tiempo de atención.
 Conclusiones: El número de pacientes atendidos en los servicios de emergencias y la complejidad de las patologías que presentan los pacientes en las salas de emergencia son factores que inciden directamente en el proceso de toma de decisiones en diagnóstico y tratamiento por el poco tiempo que tienen para el proceso de atención médica, debido a la alta demanda de atención Se requiere de políticas que mejoren las condiciones de trabajo para los profesionales de la salud, con una evaluación cuidadosa de las cargas de trabajo y tiempos de ejecución de las mismas para disminuir la posibilidad de errores en el diagnóstico y/o tratamiento de los pacientes.

Nursing Experience of COVID-19 Prevention and Control in a Regional Central Hospital in a Non-Wuhan Area in China

The article's abstract is no available.

Spectrum of heart failure in sub-Saharan Africa: data from a tertiary hospital-based registry in the eastern center of Burkina Faso.

IntroductionHeart failure (HF) is a strong contributor to non-communicable diseases burden in sub-Saharan Africa (SSA). Few studies have addressed the pattern of HF in Burkina Faso.MethodsWe conducted a prospective cohort study in patients with acute HF in the Regional Hospital Center of Tenkodogo, eastern region of Burkina Faso. Patients were consecutively enrolled from 1st January 2015 to 31st December 2016 and followed up until June 2017. Primary outcome of interest was mortality.ResultsOverall 318 of 1805 cardiac cases presented with acute HF (17.62 %). Of the 298 patients included in the analysis process, 239 had de novo HF and 150 were male. The mean age was 58.56 ± 18.54 years. Eighty-eight patients presented with atrial fibrillation. The mean left ventricular ejection fraction (LVEF) was 38.20 ± 12.85 % with reduced ejection fraction (LVEF < 40%) accounting for 59.73% of the cases. Most of the study patients lived in rural areas. Hypertensive heart disease (50.34%) and idiopathic dilated cardiomyopathy (19.80%) were the leading causes of HF. Most patients received renin-angiotensin system blockers contrasting with a lower prescription rate of beta-blockers (99% versus 18.79% respectively). The incidence of all-cause mortality was 31 percent patients-years.ConclusionHeart failure is frequent in SSA, affecting patients at younger age. Predominantly of non-ischemic cause, commonly hypertensive, the disease is associated with high mortality.

Evaluation of the interpretation criteria of Western Blot profiles for the HIV-1 infection diagnosis in a South Moroccan group

Introduction : Western Blot (WB) is the most commonly used method to confirm the presence of antibodies against Human Immunodeficiency Virus type 1 (HIV-1). The interpretation of WB, however, poses difficulties since of the multiplicity of criteria proposed by various international organizations. Some criteria generate an unacceptable number of indeterminate results, thus preventing the early management of patients. The present work aims to evaluate the different criteria for interpretation of WB according to various organizations compared to viral load test.Material and methods : This is a study carried out on a total of 2 618 Western Blot profiles registered during a period of 56 month (from January 2013 to September 2017) at the Laboratory of Medical Analysis of Regional Hospital Center in Agadir.Results : The results obtained indicate that some organizations have very interesting values concerning the positivity of the WB profiles; WHO (94.84%), CDC/ ASTPHLD (94.61%) and SFTS (93.09%). For the negative profiles, all the organizations have identical values with 3.59%. Regarding indeterminate profiles, the WHO gave the minimum of these cases (1.57%) followed by CDC / ASTPHLD (1.8%) and SFTS (3.32%). The WHO provided very interesting values for sensitivity (98.93%), specificity (91.26%), positive predictive value (99.64%) and negative predictive value (74.60%). Similarly, the CDC / ASTPHLD criteria remain favorable and are highly consistent with those of WHO (p = 0.8113).Conclusion : Sensitivity, specificity, and predictive values are characteristics of WB test that interpret the results and allow applying them to patients. In our context, it is recommended to adopt the WHO criteria to facilitate the interpretation of western blot profiles. The CDC / ASTPHLD criteria remain favorable to adoption.

Medical Emergencies in the Pediatric Service of the Lomé - Commune Regional Hospital Center (Togo)

Any health worker who cares for children will be faced with medical emergencies. They are common and can start with alarming speed, but if treated quickly and effectively, it will have most of the time a positive result, or at least better than expected [1]. In sub-Saharan Africa, pediatric emergencies are often a matter of “disaster medicine” and several studies show the extreme gravity of the conditions seen in emergency consultations [2-5].

Predictive risk factors for liver abscess rupture: A prospective study of 138 cases

Liver abscess is a serious condition due to its complications. The most frequent complication is rupture. Our aim is to determine the predictive risk factors of liver abscess rupture at the Saint Louis Regional Hospital Center.

A Study related to the management of medical and pharmaceutical wastes in Beni Mellal-Khenifra region: Beni Mellal city as a case of study

After having conducted an investigation about landfill in Beni Mellal city, Medical and Pharmaceutical Wastes (MPWs) are unloaded mixed with household and similar wastes. The objective of the present study is to analyze the management system of medical and pharmaceutical wastes at the level of Beni Mellal city in order to ameliorate the quality of collecting and handling these wastes and consequently minimizing the management costs vis a vis this service. First of all, we have created database concerning the location of health centers (HC). After, we have conducted a survey with the help of a questionnaire in different public and private health centers. Then we have carried out a research on MPWs in Dustbins existing around the health centers. We have also made an analysis of the management system of MPWs inside The Regional Hospital Center (RHC) in Beni Mellal. Afterwards, we have made a comparison between some hospital centers in Morocco when it comes to the management costs of MPWs.Based on the results obtained; we have suggested some solutions to master the management system of MPWs in addition to the scenarios for optimizing the costs linked with this service.

Gangrene of the External Genitalia at the Regional University Hospital Center of Ouahigouya: Epidemiological Profile and Therapeutic Aspects

Introduction: Gangrene of extern genitary organs is a rapidly progressive necrotizing fasciitis of the perineum and external genitalia that results from a polymicrobial infection. Mortality remains high despite advances in resuscitation. We report the experience of the surgery department of the Regional University Hospital Center (CHUR) of Ouahigouya in order to describe the epidemiological profile and the therapeutic aspects of GOGE. Patients and methods: We carried out a descriptive and analytical retrospective study collecting 41 cases of Fournier’s gangrene treated over 63 months (from March 2013 to July 2018) in the surgical department of the Ouahigouya regional university hospital center. Ethical clearance was taken from the institutional ethics committee. Results: The mean age of the patients was 65.02 ± 17.92 years with extremes of 23 years and 95 years. All patients were male. Urologic causes were the most common with 36.58% of cases. The average consultation time was 15.44 ± 16.04 days with extremes of 1 day and 60 days. All patients received resuscitation, bi or triantibiotherapy and surgical debridement. The mortality rate was 24.39%. The mean duration of hospitalization was 10.83 ± 6.257 days with extremes of 1 day and 60 days. Conclusion: The Fournier’s gangrene always has a very high lethality. Improving the prognosis requires fast and effective management.

Pancreatico duodenal trauma in children: Two-year experience at a regional referral center and tertiary care teaching hospital

Background:Pancreatico-Duodenal injuries, though rare, pose a mighty challenge to the surgeon in both diagnosis and treatment. More so in children, where the patho-physiologic threshold is low. Added to this is the absence of any strong guidelines to guide and ensure standardised care in these children for best outcome.Materials and Methods:The trauma patients' records in the emergency department, operation theatre, inpatient departmrnt, outpatient department (OPD) for the period of December 2016 to December 2018 in the institution were retrospectively reviewed, to find out the cases of pancreaticoduodenal trauma proven radiologically, biochemically and/or on laparotomy. Those cases then studied with respect to diagnosis, treatment and short term outcome.Results:Of the 256 cases of abdominal trauma, suspected pancreatico duodenal (PD) trauma were in nine but on laparotomy actually eight of them had PD trauma. All were blunt abdominal traumas sustained in road traffic accidents. Of these one was combined pancreatico duodenal while three were pure pancreatic and four were pure duodenal. One had associated superior mesenteric vein trauma. All were managed operatively. There were no mortality, one fourth had major complications. Mean hospital stay was 22.25 days. Follow up period varied from six to 32 months.Conclusion:Though PD traumas are rare but are potentially very morbid and may prove fatal. Proactive individualized management, multidisciplinary approach and good perioperative support can yield good results.