Main Reason For Consultation Research Articles

Sociodemographic, Educational and Psychological Characteristics in First-Time Consultants of Psychological Care Service

Objective: The purpose of the research was to compare the sociodemographic, educational and psychological characteristics in first-time consultants from university psychological care service after the COVID 19 pandemic. Theoretical Framework: Research has identified the need to characterize the population that receives psychological care as a priority. Method: It was a quantitative study with a cross-sectional, descriptive-correlational design. The sample consisted of 119 people (76.5% women and 23.5% men), who requested the service between the months of February and July 2023. The Anxiety Scale (BAI), the Beck Depression Scale (BDI) were used., in addition to a sociodemographic questionnaire. Results and Discussion: It was found that the population that requested the service was made up mostly of women (76.5%, n=91) of 11-21 years. “Emotional instability” (27.73%) was found as the main reason for consultation, followed by “anxiety symptoms” (17.64%) and “depressive symptoms” (9.24%). Regarding the levels of depression, it was found that 41.2% of the sample is at a moderate level, followed by a severe level in 26.9%. Regarding the levels of anxiety, it was found as mild as moderate degree in 36.1% while 21% of the consultants were at a severe level. According to the Chi Square test, it is concluded that neither depression nor anxiety depend on sex. Research Implications: The data obtained makes it possible to demonstrate the impact on mental health that the pandemic has had on university populations. Originality/Value: The results favor the possibility of developing effective care strategies according to the characterizations found.

Epidemiological, clinical and therapeutic aspects of edematous maculopathies in Cadeso/Donka

Objective: To study the epidemiological, clinical and therapeutic aspects of edematous maculopathy at CADES/O. Material and Methods: This was a descriptive cross-sectional study lasting six (6) months from April 1, 2021 to September 30, 2021 All patients with oedematous maculopathy without distinction and who had undergone at least one angiogram and/or optical coherence tomography (OCT) were included in our study. Results: During our study we received 4988 patients, of whom 180 or 3.6% had edematous maculopathies. The age group from 60 to 69 years old (30.5%) was the most represented. The mean age was 55.9± 14.2 years (20 and 89 years). Females (55%) were predominant with a sex ratio of 0.8. The majority of our patients were housewives (35.5%). 83% of our patients came from rural areas. More than half of our patients were married, a frequency of 74.4%. Hypertension was the leading cause of ATCD (67.7%) followed by age-related macular degeneration (66.6%) and diabetes (32.2%). The main reason for consultation was blurred vision (88.3%). OCT found non-cystoid macular edema and cystoid macular edema. According to the ALFEDIAM classification, OM was mainly mixed (45%), diffuse (36.1%) and focal (18.8%). 92.2% of our patients received anti-VEGF-based treatment, the evolution was favorable. Conclusion: OM is due to a loss of retinal homeostasis leading to an imbalance between fluid inputs and outputs and to altered retinal hydraulic conductivity. During our study, the prevalence of edematous maculopathies was low. Older women have been the most affected. The cost of managing edematous maculopathy should be reviewed within the reach of low-income patients to allow for adequate management. Keywords: Oedematous maculopathy, Epidemiology, Clinical, Therapeutic.

Epidemiological and Etiological Aspects of Acute Renal Failure in the Nephrology and Haemodialysis Department of the Point G University Hospital

Introduction: Acute renal failure (ARF) represents a major public health problem associated with high mortality. The incidence is increasing with the emergence of multiple risk factors. In Mali, there are currently no data on the extent and severity of this condition in either hospital or community settings. The aim of our study was to describe the epidemiological, therapeutic and prognostic aspects of ARF in adults treated at the University Hospital Centre (CHU) of Bamako. Patients and Methods: This was a retrospective and descriptive study that took place from 1 July 2021 to 30 June 2022 at the CHU du Point G in Bamako. It focused on patients hospitalised and/or followed up on an outpatient basis in the nephrology department during the study period. Results: The prevalence of acute renal failure was 11.55% with a sex ratio of 1.49. The mean age was 42.37±20.7 (range 6-88 years). Elevated plasma creatinine was the main reason for consultation. Creatinine levels were above 500µmol/l in 65.21% of cases. High blood pressure was the main presenting condition in 33.7% of cases. Acute renal failure was organic, obstructive and functional in 72.8%, 15.2% and 12% respectively. Rehydratation was used in 97.8% of cases. Dialysis was indicated in 40% of cases. Age over 60 years was a major risk factor for ARF. The outcome was favourable in 81.5% of cases. Conclusion: Mortality in dialysis patients with ARF remains high. Several factors influence the prognosis of these patients, including the severity of ARF and pre-existing comorbidity.

Secondary pseudohypoaldosteronism: a 15-year experience and a literature review.

Secondary pseudohypoaldosteronism (S-PHA) is a rare condition resulting from renal tubular resistance to aldosterone in children with urinary tract infection (UTI) and/or nephrourological malformations. It is characterized by nonspecific symptoms but with the potential for life-threatening complications. We aim to evaluate the clinical manifestations, diagnostic approach, and therapeutic interventions in children with S-PHA, along with a review of recent publications. A retrospective observational descriptive study was conducted on S-PHA cases diagnosed over the last 15years at a tertiary pediatric nephrology unit. The literature for the last 10years was reviewed. Twelve patients (10 males, 6days to 6months) were identified. Weight loss was the main reason for consultation (50%). Ninety-two percent of patients had an underlying nephrourological pathology and 62% concomitant confirmed UTI. Seven out of 12 children were admitted to the PICU. A subsequent extrapontine myelinolysis was observed in one patient as neurological sequelae. Twenty-one articles related to S-PHA have been identified on PubMed and Embase. S-PHA should be considered in infants under 6months of age with UTI and/or CAKUT. Obstructive anomalies and vesicoureteral reflux can be found, affecting both unilateral and bilateral systems. Early medical and surgical interventions are crucial and require close monitoring to avoid iatrogenic complications.

Acute Intestinal Intussusception in Children at Somine Dolo Hospital in Mopti

Introduction: It is defined as the penetration of an intestinal segment and its meso into the lumen of the distal segment by a glove-like turning mechanism (invagination sausage) whose perpetuation results in obstruction of the intestinal lumen and the intestinal necrosis. Acute intestinal intussusception (IIA) or intussusception is the most common cause of intestinal obstruction in infants. IIA is primary or idiopathic in 90% and mainly affects infants between 2 months and 2 years with a peak frequency between 6 and 9 months. Objectives: To study acute intestinal intussusception in children aged 0 to 15 years in the general surgery department of the “SOMINE DOLO” hospital in Mopti. Method: This was a retrospective, descriptive study which took place from January 2017 to September 2020 in the general surgery department of the Sominé Dolo Hospital in Mopti. Result: During the study period, 1244 children were operated on including 32 cases of IIA, representing a frequency of 2.57% of surgical interventions. The male gender was in the majority (62.5%) with a sex ratio of 1.7. The average consultation time was 6.2 ± 4.3 days. Infants were the majority in 68.8% of cases and the main reason for consultation was abdominal pain (78.1%). The average treatment time was 2.9 hours. The ileocecocolic form was more frequent in 50% cases. Manual disinvagination was most often performed in 75% and the postoperative course was simple in 56.3%. Conclusion: AII is a common condition in our structure. It mainly affects infants and boys. Patients consult late but early treatment reduces mortality.

Meckel's Diverticulitis: About 5 Pediatric Observations Collected at the Nianankoro FOMBA Hospital in Ségou, Mali

Meckel's diverticulitis or meckelitis is the infection of the Meckel's diverticulum. The aim of this work was to study the epidemiological, diagnostic, therapeutic and evolutionary aspects in the pediatric surgery department of the Nianankoro FOMBA hospital in Ségou, Mali. This was a retrospective study concerning observations between July 2010 and June 2012. We reported 5 observations in 2 years, representing a frequency of 2.5 cases per year. The average age was 6.6 years and the sex ratio was 1.5. Diagnostically, abdominal pain was the main reason for consultation followed by fever and vomiting. Physical examination found in all cases abdominal pain more or less associated with guarding in the right iliac fossa and peri-umbilical area. Abdominal bloating and contracture were noted in one case. There was hyperleukocytosis in all our 5 observations. The diagnosis was an operative discovery in 4 cases. Ultrasound was contributory in one case. Therapeutically, segmental resection of the small intestine removing the diverticulum, followed by immediate end-to-end anastomosis of the small intestine was the only technique performed in all our patients. The postoperative course was simple in 4 cases. A wall abscess with a favorable outcome was noted. Histological examination confirmed meckelitis at different stages (inflammatory, abscessed, gangrenous or necrotic). Gastric heterotopia was noted in one observation.

Uso de la ecografía clínica en Atención Primaria. Estudio prospectivo multicéntrico

ObjectiveThe objective was to describe the characteristics of the use of clinical ultrasound in two health centers (SC) of Health Area VII of the Region of Murcia (CS Murcia-Sur and CS Floridablanca). DesignObservational, descriptive, longitudinal, prospective and multicenter study. SiteCS Murcia-Sur and CS Floridablanca (Health Area VII of the Region of Murcia). ParticipantsOne hundred and thirty-five patients were included. InterventionsPerformance of clinical ultrasound in the primary care (PC) consultation. Main measurementsDemographic variables (age, sex), as well as clinical variables (reason for consultation, type of ultrasound, results, referrals to the second hospital level, degree of diagnostic agreement) were collected. ResultsOne hundred and thirty-five patients were included, more than 50% were female. The main reason for consultation was musculoskeletal and soft tissue symptoms (44.4%), followed by digestive symptoms (21.5%). 44.4% of the ultrasounds were classified as normal, while pathological findings were found in 55.6%. Confirmatory tests were requested in 43.7% and the findings were confirmed in 67% of the patients. ConclusionsThe use of ultrasound in PC allows to show the high prevalence of pathological findings in the examination of patients. In a technique that helps the clinician in his diagnostic-therapeutic process. The integration of clinical ultrasound in the PC consultation can save complementary studies and referrals to a second level of care. Its implementation in PC requires proper training of professionals.

Imported infectious diseases in migrants from Latin America: A retrospective study from a referral centre for tropical diseases in Spain, 2017–2022

IntroductionDetecting imported diseases by migrants and individuals visiting friends and relatives (VFR) is key in the prevention and management of emergent infectious diseases acquired abroad. MethodsRetrospective descriptive study on migrants and VFR from Central and South America between 2017 and 2022 attended at a National Referral Centre for Tropical Diseases in Madrid, Spain. Demographic characteristics, syndromes and confirmed travel-related diagnoses were obtained from hospital patient medical records. Results1654 cases were registered, median age of 42 years, 69.1% were female, and 55.2% were migrants. Most cases came from Bolivia (49.6%), followed by Ecuador (12.9%). Health screening while asymptomatic (31.6%) was the main reason for consultation, followed by Chagas disease follow-up (31%). Of those asymptomatic at screening, 47,2% were finally diagnosed of any disease, mainly Chagas disease (19,7%) and strongyloidiasis (10,2%) ConclusionOur study emphasizes the importance of proactive health screening to detect asymptomatic conditions in migrants and VFR, enabling timely intervention and improved health outcomes. By understanding the unique health profiles of immigrant populations, targeted public health interventions can be devised to safeguard the well-being of these vulnerable groups.

Postoperative Complications of Transvesical Adenomectomy of the Prostate in the Urology Department of the Centre Hospitalier Universitaire GABRIEL TOURE in Bamako

Objective: To study postoperative complications of transvesical adenomectomy of the prostate in the urology department of the Gabriel TOURE University Hospital in Bamako. Patients and Methods: This was a prospective, cross-sectional, descriptive study conducted over 12 months, from December 1, 2022 to November 30, 2023. It covered all patients admitted, operated on and followed up in the Urology Department of CHU Gabriel Touré for benign prostatic hypertrophy and having a complete medical record. Results: Out of 102 patients operated on for prostate adenoma in the urology department of CHU Gabriel Touré, 26 cases of postoperative complications (POC) were recorded, representing a frequency of 25.49%. The average age of our patients was 71.38 years. Urinary bilharziasis was the main urological antecedent in 50% of patients, while inguinal hernia repair was the most common surgical antecedent, accounting for 27% of cases. Pollakiuria was the main reason for consultation (46.15%). Urinary tract infection was found in 57.69% of patients, with Escherichia coli the main germ involved (34.61%). The mean ultrasound prostate weight was 63.82g, with a mean total PSA level of 2.98ng/ml. Preoperative catheterization was strongly associated with postoperative complications (37.21%). The main indication for surgery was complicated BPH (infectious complication: 38.46%). The average duration of bladder irrigation was 2.3 days. Parietal suppuration was the main postoperative complication (30.77%). Postoperative indwelling catheterization lasted an average of 16 days. The average hospital stay was 7.3 days for patients with CPO versus 5 days for other patients. The mortality rate was estimated at 3.84%. Conclusion: In our context, transvesical adenomectomy of the prostate is still the most common surgical treatment for benign prostatic hyperplasia. Postoperative complications are dominated by parietal suppuration.

Child Liver Abcess: Study of 12 Cases in the Pediatric Ward of the District Hospital of Bamako

Hepatic abscess is a suppurative collection developed in a neoformed hepatic cavity as a result of the invasion and multiplication of micro-organisms. The prognosis depends on early diagnosis and rapid treatment. The aim of the study was to determine the clinical, biological, ultrasound and therapeutic characteristics of liver abscesses in children aged between 1 month and 15 years hospitalised in the Paediatrics Ward of the District Hospital in Commune V, Bamako. This was a retrospective descriptive study which took place from January 2017 to December 2020, i.e. a period of 4 years, and a prospective study from January 2019 to December 2020, including all children aged between 1 and 15 years in whom the diagnosis of liver abscess had been confirmed by liver ultrasound. Out of 2756 children hospitalised during the study period from January 2017 to December 2020, i.e. a période of 4 years, 12 patients were diagnosed with liver abscess, i.e. a frequency of 0.43% or 4 cases/1000 admissions, with a female predominance of 58.3%, i.e. a sex ratio of 0.7. The mean age was 57 ± 34 months, with extremes of 16 and 120 months. The main reason for consultation was abdominal pain associated with fever, accounting for 75% of patients. Pus culture was positive for Staphylococcus Aureus in one patient (8%). Amebic serology was positive in 33% of patients. Ultrasound revealed a predominance of single abscesses located in the right lobe of the liver in 42% of patients. However, 92% of patients were cured, with an average hospital stay of 12 days, ranging from 2 to 19 days. Liver abscesses uncommon in our context, an early diagnosis and management can improve the prognosis.

Implementation of a vascular access team and an intravenous therapy programme: A first-year activity analysis.

Creating Vascular Access Teams (VAT) provides an expert nursing role that contributes to the training and continuous improvement of healthcare personnel. They can offer greater clinical safety, reducing complications and costs. Peripherally inserted central catheters (PICCs) and midline catheters (ML) can be safe and cost-effective alternatives to other types of venous access (VA). The aim of the study was to analyse our centre's VAT first 12 months of activity. The primary outcome was reported complications. Secondary outcomes were cause of catheter removal, consultancy activity and economic impact of VAT implantation. A longitudinal, descriptive study was carried out from March 2019 to March 2020. Using consecutive sampling, all VA inserted, and all consults received were included. Patients under 18 years of age were excluded. The VAT inserted 1257 catheters into 1056 patients (291 MLs, 966 PICCs). The mean dwell time was 14.9 days for MLs and 59.07 days for PICCs. The main reason for removing VA was end of treatment (80.7%). During VA follow-up confirmed infection was detected in 1 ML (0.3%) and nine PICCs (0.9%). Symptomatic thrombosis was reported in 2 MLs (0.7%) and 16 PICCs (1.7%). The VAT received 367 consultations, and the main reason for consultation was to resolve doubts regarding the management of VA (80.9%). The insertion of ML and PICC catheters represented annual estimated economic savings of €867,688.44€. Our study provides a detailed analysis of VAT's activity, its relevance to clinical safety, and to efficient resource management within our hospital. It demonstrates how VAT establishment can be a safe and efficient intervention that enhances care quality.

First dental consultation in pediatric patients. Machalilla, period September 2022 to July 2023

Dental caries is the most prevalent oral disease, and the main cause of tooth loss and its sequelae, in pediatric age. In Ecuador it is reported that 45% of children between 1 and 9 years old have cavities in untreated temporary teeth. The objective was to determine the age and reason for the first dental consultation in pediatric patients, in the parish of Machalilla, province of Manabí, Ecuador, in the period september 2022 to july 2023. A descriptive study was carried out that included all children aged 0 – 14 years who received a dental consultation for the first time in the First Level Health Center, or in extramural visits in the community. All guardians and caregivers signed the informed consent for their dental care. During the period, 54 patients were treated, 35 (64.9%) in extramural visits and 19 (35.1%) in the dental office, the majority in the age group of 1-4 years, with 26 (48.1%) children, and the main reason for consultation was for a dental examination, 39 (72.3%) children. From the clinical examination carried out, it was determined that 37 children (68.5%) had dental caries and needed conservative restorative treatments or tooth extraction. The results indicate that it is necessary to improve health education and oral disease prevention actions in the pediatric population of Machalilla, involving their guardians and caregivers from an early age

Contribution of Optical Coherence Tomography in the Diagnosis and Follow-up of Primary Open-Angle Glaucoma

Objective: To study the contribution of OCT in the diagnosis and follow-up of POAG at the ophthalmological clinic of the University Hospital Center in the Suru Lere area and at the ophthalmological clinic of HIA - CHU. Method: This is a descriptive and analytical study, retrospective over a period of 7 years from 1st January 2015 to 31st December 2021. Results: We identified a total of 30 patients, i.e. 60 glaucomatous eyes, in whom at least two OCTs were performed. The average age of the patients was 51.23 ± 12.16 years with extreme values of 23 to 72 years. In our series, 17 patients were male (56.65%), i.e. an M/F sex ratio of 1.30, employees were in the majority and represented 66.67% of patients, patients with no history represented 60 %. The main risk factors were hypertension, HT0 with respectively 20%, 13.33%. Visual loss was the main reason for consultation, 56.67%. The average cup/disc ratios on clinical examination of the papilla are respectively 0.57 ± 0.19 on the right and 0.58 ±0.18 on the left. In our series, the means of the three OCTs for the C/D ratios were established respectively at 0.70, 0.71 and 0.62 for the right eye and respectively 0.70, 0.71 and 0.65 for the left eye. Regarding the mean of the per papillary RNFL, the means of the three OCTs are respectively 86.27; 83.93; 86.29 for the must eye and 89.20 respectively; 83.47; 85.07 for the left eye. For the ganglion cell complex the results were respectively 85.63; 81.73, 71.71 for the right eye and 86.07 respectively; 81.23 and 71.86 for the left eye. There was a significant correlation between fundoscopic and tomographic vertical C/D ratios. Conclusion: It appears from this work that OCT is an essential material examination and plays an important role in both the diagnosis and the follow-up of glaucomatous disease.

Etiological Factors of Ocular Trauma in Children and Adolescents Based on 200 Cases at the Pediatric Ophthalmology Unit of the Bouaké University Hospital

Background: Eye trauma is serious and very often has a poor prognosis in our environment. The aim of this study was to contribute to improving the prevention of ocular trauma in children and adolescents in central and northern Côte d’Ivoire. Methods: This was a cross-sectional study with a descriptive aim on 200 patient files received at the pediatric ophthalmology unit of the ophthalmology department of the Bouaké University Hospital from January 6, 2021, to July 7, 2023. In these patients, the questioning and clinical examination revealed ocular lesions linked to trauma. The parameters studied were socio-demographic characteristics (age, sex, origin, educational status), reason for consultation, ophthalmological history and etiological factors (circumstances of occurrence, vulnerating agent and mechanism of occurrence). Data analysis was carried out using epi-info 7.0 software. Findings: The average age of the patients was 8.45 ± 4.62 years with a range of 1 to 19 years. Boys were the most affected (71%) and this male predominance was found in all age groups. The 5-9-year-old age group was the most represented (31%). Children in primary school were the most numerous (40%), followed by those in secondary school (26%) and those not in school (25%). Almost all the children came from urban areas (75%). Ocular trauma was the main reason for consultation (75%) and the most common ophthalmological history (80%). The circumstances of occurrence were dominated by gaming accidents (48.50%), domestic accidents (19.50%) and brawls (15.50%). The most common damaging agent found was metallic (25%) followed by the stone used as a projectile (18.50%) and the punch (17%). The mechanism of trauma was dominated by the reception of a moving object or liquid on the eye (96%). Conclusion: Given the high proportion of school boys who are victims of eye trauma, school programs should include raising awareness among children at school about the risks of accidents and in particular eye trauma and the means of preventing them. Action should also be taken in rural areas and through the Chamber of Trades of Côte d’Ivoire with a view to preventing eye trauma in children and adolescents in farming activities and in craft workshops where those are often in apprenticeship.

Characteristics and Management of Pyogenic Liver Abscess: A Rural Senegalese Experience

Background: The incidence of pyogenic liver abscess (PLA) has increased in recent years with the development of digestive surgery, particularly hepatobiliary surgery. In recent decades, progress in diagnostic techniques have improved patient prognosis. In Senegal, there are few studies of PLA. This study was carried out within this context.
 Objective: The main objective was to describe the profile and the management of pyogenic liver abscesses cases in rural Senegal.
 Results: We collected 17 cases of PLA among 47.553 patients, during the study period, representing a hospital frequency of 0.035%. The mean age of patients was 48.6 ± 18.9. The sex ratio (M/F) was 2:4. Most of the patients (58.82%) had at least one risk factor, the main ones being smoking, a history of abdominal surgery and alcoholism. Right upper abdominal pain was the main reason for consultation (94.11%). Right basithoracic pain and cough were the most frequent respiratory symptoms. Escherichia coli remained the most frequently isolated bacteria. The mean time to diagnosis was 17.8 days ± 14.4. All patients received antibiotic therapy, which was combined with echo-guided liver aspiration in 58.82% cases. Mean hospital stay was 17.5 days ± 7.65. The hospital lethality rate was 29.41%.
 Conclusion: Liver abscesses are most often of amoebic origin in our context, but in recent years there has been an increase in cases of pyogenic liver abscesses, with the progress made in diagnosis.

Prevalence of risk factors associated with development of capsular contracture after placement of breast implants.

To determinate the prevalence of the main risk factors associated with development of capsular contracture after placement of breast implants in a referral center. Retrospect study on 210 patients where sociodemographic variables, Baker's clinical scale and histopathological results were recorded. Statistical analysis of 210 patients was performed; 98.1% were women. The average age was 47 years (± 11), body mass index 25 (± 10) and onset of symptoms 13 years (± 8.5). Sociodemographic factors: domestic work 63.3%. Alcoholism 70% and smoking 65.7%. The main reason for consultation was pain plus deformity in 81.6%. The risk factors with statistical significance were the history of trauma, with 83.3% (p = 0.004), and the subglandular plane, with 73.8% (p = 0.0115). Histopathology: fibrous capsule 81.4%. The prevalence of the risk factors described are similar to those reported in the literature. Only for the history of trauma and the subglandular plane there was statistical significance.

Analisys of e-consults in a cardioly department. More than future

Abstract Background Telemedicine is a new concept in the healthcare sector but due to the recent rapid technological advancements, it has been growing expeditiously, helped by the COVID-19 pandemic. In the field of cardiology, it has been gaining importance, and it can help to reduce waiting lists, which in countries like Spain can be months long. Mainly in certain procedures that do not require an anamnesis or a face-to-face physical examination by the cardiologist. Purpose Evaluate the main reasons for teleconsultation in our cardiology department (since its launch in 2021) from general practitioners, to develop training programs and how to optimize this type of consultation. Methods We conducted a retrospective study at our hospital, analyzing all teleconsultations since the cardiology program began in 2021. For each teleconsultation, we analyzed: the reason for the consultation, the response time of the cardiologist, if the patient was referred for a face-to-face consultation, and if changes were made in the treatment of the patients. Results We evaluated a total of 330 teleconsultations from 12 health centers whose patients corresponded to our service. The median age was 70 (±18,9) years and 55.7% were men. A growing trend in its use was observed from November 2021 to January 2023, going from 12 to 32 teleconsultations per month .The main reason for consultation was ECG doubts (47%), followed by the management of atrial fibrillation (20%) and the management of drugs in ischemic heart disease (10.6%). The rest were related to AHT control (4.5%), management of palpitations (3%) or congestion in heart failure (2%). Within the teleconsultations, 100% were resolved electronically, requiring face-to-face follow-up in only 22.4% of them. They were answered in an average of 2.1 (±2,6) days from their referral by the primary care physician and only 40% of the patients required changes in treatment. Regarding the doubts in the ECG, 73% were compatible variations from normality that did not require further follow-up. Among the questions in AF, 56% were based on doubts about anticoagulation, 13% about adverse effects in the medication, and 7% about heart rate control. 68% of teleconsultations about ischemic heart disease were about the duration of dual antiplatelet therapy. Conclusion(s) Teleconsultation in the field of cardiology is a very useful tool that allows contact between the cardiologist and the primary care physician in a short time without the need for the patient to attend emergency services (which are increasingly overloaded with non-urgent consultations) or wait for physical consultation for long periods of time. The field of teleconsultations should be restricted to assessments where the physical examination or patient history by the cardiologist is not essential, being limited to certain fields.

GLIOMA-08 INTRACRANIAL HIGH-GRADE GLIOMA MANAGEMENT IN COTE D’IVOIRE : ABOUT 19 COALIGATED CASES FROM MARCH 2019 TO JUNE 2021

Abstract INTRODUCTION Intracranial malignant gliomas are serious conditions that constitute a therapeutic challenge. In Côte d'Ivoire, since 2019, their care meets international standards with the advent of the National Center of Radiotherapy and Medical Oncology Alassane Ouattara and interdisciplinary consultation meetings. Our objective was to evaluate the morbidity and mortality of patients treated for high-grade gliomas in Côte d'Ivoire. MATERIALS AND METHODS We realized from March 2019 to June 2021, a retrospective cohort study on 19 patients with malignant intracranial glioma, without distinction of age and sex, whether alive or deceased. They were 12 male patients and 07 female patients. The parameters studied were, among others, the type and quality of complementary treatment, the evolution under treatment, and the time to onset of recurrence and death. RESULTS The time to consultation was early in 57.9% of cases. High ICP syndrome was the main reason for consultation at 51.6%, followed by neurological deficit. Surgery was performed on average in all patients within 30 days after imaging. The histological diagnosis of grade 4 glioma was pronounced in 16 patients. Postoperative radiotherapy was performed in 94.7% of cases, associated with concomitant then adjuvant chemotherapy with temozolomide in 84.2% of patients. During the treatment, two cases of local recurrence were notified. At the end of the cohort, the death rate was estimated at 73.7%, with a median survival of 11 months and extremes ranging from 06 months to 34 months. CONCLUSION Despite the availability and application of reference therapeutic processes, malignant glioma remains, due to many factors related to our context, a very pejorative prognosis. This study should continue with the inclusion of a larger number of patients in order to review the state of play of the management of high-grade gliomas in Côte d'Ivoire.

Pott’s disease surgery in Senegal: Management difficulties and results of 212 cases in a developing country

IntroductionTuberculosis is still a major public health issue in low and middle income countries worsened by the HIV/AIDS pandemic and social precarity. Delayed diagnosis of Pott's disease is frequently observed in our environment, leading to neurological complications and spinal deformities despite improved equipment. The objective of this study is to reveal the difficulties encountered in the surgical management of this disease in our working setting, and to report our results. MethodThis was a descriptive, retrospective, multicenter analysis including all patients with surgical treatment for Pott's disease between January 2015 and July 2021 in 5 neurosurgical centers in Senegal. ResultsDuring our study period, of the 212 patients operated on for Pott’s disease, the average age was 38.8 ± 11.1 years, with extremes of 10 and 65 years, 58.9% of whom were male, with a sex ratio of 1.3. Spinal pain was the main reason for consultation (62.2%), with an average time to consultation of 9.3 months. Patients had poor overall condition (47.1%), spinal symptoms (85.3% of cases) and neurological deficits (35.8%). Thoracic localization was the most frequent, at 43.8%. Histological diagnosis was made in 74% of cases. The indications for surgery was neurological deficit, signs of spinal instability or deformity. All patients, in addition to 12 months anti-tuberculosis treatment, underwent surgery with a mean time to surgery of 21.2 days. The posterior approach was the most common, 92.4%. Neurological improvement was observed in 76.3% of patients after one year, with vertebral fusion in all. Mortality was 1.8% (4 patients). ConclusionPott's disease remains a topical pathology in Senegal. This study shows that surgery provides good results despite the delay in diagnosis and the difficulties of management linked to the low socio-economic status of patients.

Perceptions and attitudes regarding delayed antibiotic prescription for respiratory tract infections: a qualitative study

BackgroundAntibiotics are overprescribed for respiratory tract infections (RTIs). However, the decision to prescribe is often complex. Delayed antibiotic prescription (DAP), a strategy designed to promote more rational antibiotic use, is still not widely used. The aim of this study was to explore perceptions and attitudes in primary care professionals, regarding antibiotic use and different DAP strategies for uncomplicated RTIs.MethodsWe conducted a qualitative study, using an inductive thematic approach to generate themes, based on focus group discussions and semi-structured interviews with professionals, recruited from 6 primary care centres (Barcelona metropolitan area, Spain).Results26 professionals (25 family physicians and one nurse) were included in four focus group discussions and three semi-structured interviews. Participants commented that RTIs were a main reason for consultation, motivated often by patient anxiety and fear of possible complications, and this was associated with the patients’ poor health-related education. Acknowledging inappropriate antibiotic use in the health system, participants attributed this, mainly to defensive medicine strategies. DAP was used when in doubt about the aetiology, and considering factors related to patient-physician interactions. The main perceived advantage of DAP was that it could reduce the need for additional visits, while the main disadvantage was uncertainty regarding proper use by the patient.ConclusionsDAP was used by participants in cases of doubt, in specific situations, and for specific patient profiles. Weak points were detected in our primary care system and its users that affect the proper use of both antibiotics and DAP, namely, time pressure on professionals, poor patient health-related education, and the lack of a patient-physician relationship in some scenarios.