Yalgado Ouedraogo University Hospital Center Research Articles

Influence of seasonal variations on admissions and deaths of pulmonary embolism in the Cardiology Department of the Yalgado Ouedraogo University Hospital Center, Ouagadougou, Burkina Faso

Influence of seasonal variations on admissions and deaths of pulmonary embolism in the Cardiology Department of the Yalgado Ouedraogo University Hospital Center, Ouagadougou, Burkina Faso

Evaluation of the fertility of patients after myomectomy in the department of Gynecology-Obstetrics of the Yalgado Ouedraogo University Hospital Center in Ouagadougou, Burkina Faso

Objective: To assess the fertility of patients after myomectomy in the Department of Gynecology-Obstetrics of the Yalgado Ouedraogo University Hospital Center from September 1, 2014 to August 31, 2018. Patients and methods: This were a retrospective cross-sectional descriptive and analytical exposure study with repeated survey and included patients of childbearing age who had undergone myomectomy during the study period; whose myomectomy is at least six (06) months old; having expressed a desire to become pregnant for at least twelve (12) months according to the definition of infertility; and having given their informed consent to the interview. Results: A total of 102 patients were included in our study. Infertility was primary in 64.71% and secondary in 35.29%. The mean age of the patients was 35.08 ± 5.42 years. Housewives accounted for 37.25%, and married women 66% of patients. After the myomectomy, 44 respondents (43.14%) achieved pregnancy; including 28/66 patients after primary infertility, and 16/36 after secondary infertility. The mean time to conception was 5.63 ± 3.46 months after the start of her postoperative quest. We observed 90.91% live births. Cesarean section was performed in 82.5% of patients and vaginal route in 17.5% of them. The main factors associated with fertility after myomectomy were: young age (p = 0.000), duration of infertility (p = 0.000), normal hysterosalpingography result (p = 0.000) and normal result spermogram of the spouse (p = 0.029). Conclusion: The relationship between myoma and infertility has not been clearly demonstrated. However, based on our results and given the difficulty of accessing ART, it seems lawful to us to offer myomectomy to patients with infertility associated with myomas, especially in patients under 35 years of age. A larger study would better establish the impact of myomectomy on the subsequent fertility of patients.

Evaluation of the fertility of patients after myomectomy in the department of Gynecology-Obstetrics of the Yalgado Ouedraogo University Hospital Center in Ouagadougou, Burkina Faso

Evaluation of the fertility of patients after myomectomy in the department of Gynecology-Obstetrics of the Yalgado Ouedraogo University Hospital Center in Ouagadougou, Burkina Faso

Nutritional status of patients according to the stage of chronic renal failure

Introduction. In Burkina Faso, chronic kidney disease (CKD) is a major public health problem due to its increasing prevalence, severity and the high cost of treatment. Aim. The aim of this study was to describe nutritional status of subjects diagnosed with severe and moderate stages of chronic renal insufficiency, followed in nephrology consultation at the Yalgado Ouedraogo University Hospital Center (YO-UHC) of Ouagadougou. Methods. A descriptive cross-sectional study conducted over a period of eight months and included 75 patients in total. The social-demographic parameters were determined on the basis of the patients' declaration and the use of their medical records. Biological parameters were collected from the results of laboratory examinations performed by each patient. The nutritional status of the patients was assessed by the anthropometric method. Finally, all patients were asked about their dietary habits and lifestyle using the 24-hour recall method. Results. Our results revealed a male predominance, out of the total number of patients included. The percentage of men and women was 54.70% and 45.30% respectively with a sex (male/female) ratio of 1.20. The average of Body Mass Index was 24.79 Kg/m2. The percentage of overweight and obesity of women was 64.71% compared to 26.83% for men. The proportion of women with severe chronic kidney disease (58.82%) was twice as high as that of men (29.27%), (P<0.05). The average waist circumference of the subjects aged 30-39 years was significantly lower than that of the subjects aged 60-85 years. So, average hip circumference was 93.77 cm, with a significant difference according to sex (P<0.05). The prevalence of hyperglycaemia and diabetes increased with age. Hyperglycaemia in the 40-49 age group was increased significantly from 16.67% to 26.67% in the 70-85 age group (P<0.05). Diabetes in the 50-59 age group was 10% and doubled in the 70-85 age group (P<0.05). A percentage of 67.99% of the patients had a history of hypertension in either first-degree relatives or collaterals. The highest proportion was found in the hypertensive collaterals (37.33%; P=0.059). This study revealed a low level of physical activity among all patients. Only 38.67% of the patients practiced regular physical activity. There was no significant association between the level of physical activity and the stage of renal failure. Conclusion. Knowledge of nutritional status is a crucial part of better nutritional management of CKD patients. Finally, previous studies on the dietary habits of patients suffering from CKD will allow a better understanding of their nutritional status for a better management according to the stage of progression of the disease.

Mortality of Traumatic Injuries in Traumatological Emergencies of the Yalgado Ouedraogo University Hospital Center in Ouagadougou (Burkina Faso)

Background: Serious trauma is the main cause of death for people under 40 years old. According to the WHO, in 2002, nearly 1.2 million people died worldwide from road traffic injuries. The vast majority (90%) are from low and middle-income countries. The diagnostic performance, the quality of the treatments offered, and the optimization of trauma care channels, make it possible to improve the management of serious trauma. This is not always the case in our context of a country with limited resources. Objectives: The objective is o describe the epidemiological, diagnostic and therapeutic aspects of premortal death in patients with traumatic injuries. Methods: This was a descriptive study with retrospective collection in the trauma emergency department of Yalgado Ouedraogo Teaching Hospital (Ouagadougou, Burkina Faso). All patients who died on the ward while in the hospital or on arrival were included. Results: 192 deaths were listed. The annual mortality was 1.6%, the sex ratio was 6.1 and the average age was 36 years. Road traffic accidents were the main etiology: 163 deaths (85%). Head injuries were the most common injuries: 45.3% of deceased patients had a Glasgow score ≤ 8. There was no pre-hospital care in 63% of the patients who died. The first six hours, on-call periods and the weekend were correlated with the death rate. Discussion: the high mortality in road traffic accident injuries in Africa is due to the weakness of pre-hospital care, the non-medicalization of the transport of the injured and also the non-wearing of helmets by motorcyclists. The MGAP (Mechanism, Glasgow coma scale, Age, arterial Pressure) score is reliable in predicting the mortality of serious injuries.

Prevalence of obstructive sleep apnoea in sleep consultations in Burkina Faso: Implications for monitoring.

Background Obstructive sleep apnoea syndrome (OSAS) is the most common respiratory disorder related to sleep. Its prevalence in developed countries varies from 3% to 28%. In several African countries, including Burkina Faso, this syndrome is still under-diagnosed and goes largely untreated. It is necessary to conduct studies in different contexts to determine the characteristics and develop the strategies for management of OSAS. Objectives To determine the prevalence of OSAS in Burkina Faso. Methods This prospective study recruited 106 patients coming for consultation for sleep disorders at the Yalgado Ouedraogo University Hospital Center, who responded to a self-questionnaire and were diagnosed by respiratory polygraphy. Results A total of 77 patients (72.6%) had OSAS. The male to female ratio was 1.4:1 and the mean (standard deviation) age was 47.8 (12.8) years. The majority of the patients (53.8%) were obese. The main reason for consultation was snoring (84%), followed by hypopnea-apnoea reported (59.4%) and daytime sleepiness (45.3%). The most common comorbidity factor was hypertension (50%), followed by decreased libido (16%) and diabetes (13.2%). A continuous positive-pressure (CPAP) machine was prescribed to 51.25% of the patients, but only 22% were able to acquire it. Conclusion The monitoring of OSAS is relatively new in Burkina Faso. This study showed the profile of patients with OSAS and difficulties in accessing continuous positive airway pressure (CPAP) devices for treatment.

Maternal Mortality in the Gynecology-Obstetric Department at the Yalgado Ouedraogo University Hospital Center (CHUYO), Burkina Faso: About 181 Cases Collected from January 1<sup>st</sup> to December 31<sup>st</sup> 2016

Objective: To study maternal mortality in the obstetrics and gynecology department at Yalgado Ouedraogo teaching Hospital Center. Patients and Methods: We conducted a cross-sectional retrospective and descriptive study of 181 cases of maternal deaths during study period. The parameters studied were sociodemographic characteristics, the causes of death, the clinical data and the contributing factors. Results: The maternal mortality ratio was 2624 per 100,000 live births. The mean age of death was 26.79 with extremes of 15 years to 40 years. Direct obstetric causes accounted for 58% dominated by hypertension and complications, hemorrhage during pregnancy and postpartum, and obstetric infections. The indirect obstetric causes were 42% dominated by non-obstetric infections and chronic anemias. In addition to the delay in consultation and delay in care, the lack of antenatal care was the contributing factor to maternal deaths. Conclusion: Maternal mortality remains a public health problem in view of its high ratio. The reduction of this scourge will inevitably go through a health insurance that will allow the supply of quality care.

Diagnosis and management of a giant ovarian cyst in the gravid-puerperium period: a case report

BackgroundGiant ovarian cyst is very rare in gravid-puerperium period. It is a cause of a maternal-fetal morbidity. We report a case of a giant benign ovarian cyst in gravid-puerperium period which was diagnosed and managed in a hospital of a low-resource country.Case presentationData were collected by historical review, clinical examination, laboratory investigations, imaging examination, and by histopathological study of the excised surgical specimen. It is the case of a 25-year-old woman who was third gravida and third para with unknown pathological history. After she had given birth through vagina, a giant ovarian cyst, unknown during pregnancy, was diagnosed. A left oophorectomy carrying the cyst was performed after laparotomy in Yalgado Ouedraogo University Hospital Center of Ouagadougou (Burkina Faso). The cyst was 42 cm long and weighed 19.7 kg. The histology of the operative specimen revealed serous cystadenoma of the ovary. The postoperative course was uneventful.ConclusionThis case reports that vaginal delivery is possible with a giant ovarian cyst associated with pregnancy. Surgical management of the cyst can be performed in the postpartum with satisfaction.

P1‐045: Treatment of chronic hepatitis B with nucleoside analogues in cirrhotic patients at Yalgado Ouedraogo University Hospital Center of Ouagadougou: about 38 cases

P1‐045: Treatment of chronic hepatitis B with nucleoside analogues in cirrhotic patients at Yalgado Ouedraogo University Hospital Center of Ouagadougou: about 38 cases

Osteosynthesis Results of Tibia Plateau Fractures at the Yalgado Ouedraogo University Hospital Center

The sophistication of the implants allows the extension of the surgical indications for tibia plateau fractures. These fractures, which are often comminuted, are caused by a high velocity trauma, making treatment difficult. Objective: The aim of this study was to determine the indications for osteosynthesis of tibia plateau fractures in the orthopaedic-traumatology department of the Yalgado Ouedraogo University Hospital, in order to evaluate the results for their better management. Patients and Methods: it was a 5-year retrospective study of the records of patients with tibia plateau fracture operated and hospitalized in our department. The anatomical-clinical and therapeutic aspects collected from the complete files were analysed. A cortico-cancellous graft was performed in 67.4% of cases. The results were evaluated according to the criteria of Merle d’Aubigne and Mazas [1]. Road traffic accidents (97.4%) were the predominant etiology, involving mainly motorcycles (97.8%). Results: Spino-tuberository and uni-tuberository fractures were the most common. The average consolidation time was 12.5 weeks. One urinary infection, 3 superficial suppurations, 3 vicious calluses and 2 equipment dismantlings were the main complications. Our results were excellent and good in 91.3% and fair in 6.5%. Osteosynthesis of tibial plateau fractures provides excellent results and remains the most appropriate procedure to treat these fractures. Conclusion: reduce the operating time, modernize the technical platform, will allow stable osteosynthesis and early functional rehabilitation to optimize their results.

Indications and Results of Surgical Treatment of Proximal Femoral Fractures in Adults at Ouagadougou

Background: Functional treatment of proximal femur fractures (PFF) is being discontinued with advances in surgery and anesthesia. Suspension traction is used as a waiting treatment before surgery when technical, material and financial conditions are not met. The surgical treatment of these fractures must ensure a stable reduction and fixation, to allow early support to the patient who will quickly regain his previous autonomy. Objective: To specify the indications for surgical treatment of proximal fractures in adult in order to evaluate the results in the context of Burkina Faso. Patients and Methods: We conducted a retrospective study including adult patients hospitalized and followed up for proximal femoral fracture (PFF) in the orthopedic-traumatology department of the Yalgado Ouedraogo University Hospital Center at Ouagadougou. Among 310 patients presenting with PFF in 5.5 years, (56 cases a year (10.4%)), we focused on those whose PFFs were treated by surgical methods and followed up. Patients treated with orthopedic (40.1%) or functional (6.8%) methods, patients with incomplete records and those having signed a discharge against medical advice were excluded. A total of 94 patients, with 95 PFFs treated by surgical methods, constituted our study population. Road traffic accidents (51.1%) and domestic accidents (48.9%) were the predominant etiologies. The functional criteria of Postel Merle d’Aubigné (PMA) were used for the evaluation of the results (Table 1). Results: A total of 65 men and 29 women (sex ratio 2.2), aged of average 56 years, were recorded. Trochanteric mass fractures were predominant with 63 cases (66.3%), including one case of bilateral fracture and one case of an open fracture; we also reported 32 femoral neck fractures (33.7%). Osteosynthesis was performed in 66 patients (70.2%) and hip arthroplasty in the remaining 28 patients (29.8%). Osteosynthesis with DHS plate screws was performed in 49 cases (73.1%) and Moore type cephalic arthroplasty in 18 cases (64.3%). Two patients (2.1%) died, one in shock state and the second by pulmonary embolism. The main complications were 3 superficial infections (3.16%), 10 painful coxitis (35.7%) and one pseudarthrosis (dismantling of the material). Despite these complications, functional outcomes were satisfactory in 88.7%, poor in 9.7% and fair in 1.6%. Conclusion: Surgical treatment of proximal femoral fractures allows early removal and rapid functional rehabilitation; which improves functional outcomes and increases the quality of life in elderly patients.

English

Increasing bacterial resistance to antimicrobial agents has become an issue of concern. A major problem of the treatment of infections caused by Enterobacteriaceae using antibiotics is the emergence of Extended-spectrum β-lactamases (ESBL)-producing Enterobacteriaceae. This study aims to determine the prevalence of ESBL-producing Enterobacteriaceae strains in Ouagadougou, Burkina Faso, and describe their resistance profile to other antibiotics commonly used in the infections treatment. 486 clinical strains of Enterobacteriaceae were obtained from patients attending three health centers in Ouagadougou (Burkina Faso) from November 2014 to October 2015. Biochemical identification was performed and antibiotics susceptibility test was performed using the disk diffusion method. Data was analyzed with the Excel and ANOVA one-way software GraphPad Prism version 5.01 software. Results revealed occurrence of Escherichia coli (60.9%, 194) predominated followed by Klebsiella spp. (22.4%, 109). Antibiotics susceptibility test revealed that 86.8% strains were resistant to amoxicillin, 81.3% to trimethoprim-sulfamethoxazole, 61.9% to ceftriaxone, 58.6% to cefotaxime and 58.4% to cefepime. It was observed that 99.8% were susceptible to imipenem while 16.6% were resistant to fosfomycin and 12.3% to amikacin. However, 38.5% (187/486) of the strains were ESBL-producing, 67.9% (127/187) of which came from Yalgado Ouedraogo University Hospital Center, 23.5% (44/187) from Charles De Gaulle Paediatric University Hospital Center and 8.6% (16/187) from Saint Camille Hospital. This study thus showed a high prevalence of Extended-Spectrum Β-Lactamases producing Enterobacteriaceae strains in Ouagadougou (38.5%). It underlined the need for routine detection and systematic reporting of ESBL strains in different health facilities in Burkina Faso, so that measures could be taken to prevent their spread and treatment failures. Key words: Enterobacteriaceae, Extended-Spectrum Beta-lactamases (ESBL), Burkina Faso.

Antimicrobial susceptibility of extended-spectrum beta-lactamase producing <i>Enterobacteriaceae</i> causing urinary tract infections in Ouagadougou, Burkina Faso

Objective: To determine the frequency of extended-spectrum beta lactamase producing Enterobacteriaceae (ESBL) and other antibioticsresistant bacteria in urinary tract isolates.Study Design: prospective and experimental study.Methodology: Place and duration of study :YalgadoOuedraogo University Hospital Center, Charles De Gaulle Pediatric Hospital Center, Saint Camille Hospital and National Public Health Laboratory, Ouagadougou, from November 2014 to October 2015.AllEnterobacteriaceaestrains isolated from urinary samples of patients were identifiedusing API 20E chemical gallery (BioMerieux, France). All strains were subjected to an array of 14 antibiotics to study their drug susceptibility by using Kirby- Baeurdisk diffusion method. Detection of ESBL was carried out by double disk diffusion technique. Statistical analysis was performed by Microsoft Excel and Anova one-way GrapPad Prism version 5.01. Chi-square (χ2) test was used to determine significance. A p˂ 0.05was considered to be statistically significant.Results: A total of 324 isolates of Enterobacteriaceae were identified during the study period, including211(65%) E. coli, 75 (23%)Klebsiella spp., 18 (6%) Enterobacter spp., 11 (3%)Proteus spp., 5 (2%) Citrobacter spp., Serratia spp. 3 (1%).All the clinical isolates were susceptible to imipenem. Resistance to amikacinwas 14% (45/324); gentamicin 54% (175/324); tobramycin 58% (187/324); nalidixic acid 72% (234/324),ciprofloxacin 63% (204/324) and to cotrimoxazole 83% (269/324).The overall rate of the EBSL producing strains was 35% (114/324). Their susceptibility to antibiotics was (imipenem,amikacin, cefoxitin and fosfomycin) 100% (114/114), 93% (106/114), 74% (84/114) and 84% (96/114) respectively. ESBL positivity within individual organism group was highest inEscherichia coli 64% (73/324) followed byKlebsiellaspp. 28% (32/324), Enterobacterspp. 3% (4/324), Proteus spp. and Citrobacterspp. 2% (2/324).Conclusion: The results showeda high frequency of ESBL producing Enterobacteriaceae, especially Escherichia coli and Klebsiellaspp. The data points to theneed of routine detection and surveillance of ESBL producing bacteria in Burkina Faso.Keywords: Antimicrobial susceptibility, Enterobacteriaceae, Urine, Burkina Faso

Improving Blood Transfusion Safety: A Survey on the Knowledge and Attitudes of Health Professionals in Blood Transfusion at the Yalgado Ouedraogo University Hospital Center, Burkina Faso

1.1.Introduction: National guidelines for best transfusion practices have been disseminated so that their recommendations can be applied to any health facility. This work was part of the approach to promoting transfusion safety. Its objective was to study the knowledge and attitudes of the clinical healthcare professionals in the Yalgado Ouedraogo University Hospital in the field of blood transfusion. 1.2.Materials and Methods: The survey-type study was conducted in four clinical departments of the Yalgado Ouedraogo University Hospital Center based on a questionnaire. It involved professionals practicing blood transfusion. The anonymous questionnaire was filled out by the participants themselves. There were multiple-choice questions and open-ended questions. 1.3.Results: The participation rate was 64% (192/300). The respondents had an average of 7 years of professional practice and worked in departments such as gynecology and obstetrics, pediatrics, nephrology and medical emergencies respectively in 48%, 26%, 16% and 10% of the cases. The study showed that transfusion therapy is a daily practice in clinical departments. However, knowledge is insufficient and compliance with transfusion best practices is limited. 1.4.Conclusion: In order to sensitize health professionals on the particular issue of blood transfusion and to improve their knowledge/skills, continuous training of health workers involved in blood transfusion should be an integral part of the action plans of the medical facilities.

The Destombes-Rosai-Dorfman Disease or Sinus Histiocytosis with Massive Lymphadenopathy: A Rare Case Described in the Paediatrics Department of Yalgado Ouedraogo University Hospital

Destombes-Rosai-Dorfman’ disease (DRD) is an inflammatory non-langerhansian histiocytosis with adenomegaly. It is a rare histiocytic disorder worldwide, less than 1000 reported cases. It is of unknown etiology and is characterized in its classical form by multiple adenomegalia, especially localized at cervical area, but also at mediastinal, axillary and inguinal areas. It is a benign condition, even if it is deforming, with spontaneously resolving evolution. We report a case of DRD disease in a 13-year-old girl, hospitalized in the Department of Pediatrics of the Yalgado Ouedraogo University Hospital Center in Ouagadougou, in March 2015. She was admitted for a voluminous bilateral painless cervical swelling, with no sign of local compression, having been operating for about a year. Biological tests showed signs of chronic inflammation; the imagery specified the benign character of these formations: adenomegalia. Confirmation of the diagnosis was made by pathological examination, describing the aspect of emperipolesis to histology and, immunohistochemistry, polytypic plasmacytosis and PS100 positive/CD1a histiocytosis negative. The treatment could not be properly carried out, in view of the early discharge, against medical advice from the patient. The evolution would have been marked, according to the parents, by a slight involution of swelling.

Non-Infectious Complications of Non-Tunneled Central Venous Catheterization for Hemodialysis: Incidence and Reasons in Ouagadougou (Burkina Faso)

Goal: Evaluate the importance and reasons of non-infectious complications of non-tunneled central venous catheterization in our hemodialysis unit. Patients and methods: The study, a prospective type, was conducted in the department of nephrology and hemodialysis of Yalgado Ouedraogo University Hospital Center (YO-UHC) in Ouagadougou, Burkina Faso, from 15 February to 30 June 2015. Patients in whom a new central venous catheter (CVC) was inserted during the study period were included. Catheterization-related complications were noted. Results: During the study period, 156 CVCs (9 per week) were placed in femoral (56.4%), internal jugular (40.4%) or subclavian vein (3.2%). There were 114 patients (59.7% of men and 40.3% of women), average age 41.8 ± 17.1 years, low socio-economic level in 64% of cases. At least a non-infectious complication was observed in 67 cases representing 42.9%. They were: puncture failure (40%), arterial puncture (12.2%), puncture of the thoracic duct (1.3%), pneumothorax (1.3%), bleeding related to the catheter insertion (5.8%), hematoma (1.3%), opposite direction (0.6%), dysfunction of the CVC (10.3%), femoralthrombophlebitis (3.2%). Conclusion: Non-infectious complications of non-tunneled central venous catheterization in our hemodialysis unit were frequent and sometimes severe. Their common denominator was the absence of ultrasound guidance. Our study reaffirms the need for equipping with Doppler ultrasound in our hemodialysis units, even in developing countries, for better security of the patient during central venous catheterization.

Rabies in Children: Report of 24 Cases at the Yalgado Ouedraogo University Hospital Center of Ouagadougou in Burkina Faso

Introduction/Objectives: Rabies is responsible for more than annual 55000 deaths in the world including 24000 in Africa. This study aims to study the epidemiological and clinical aspects of rabies in children at the University Hospital Center Yalgado Ouedraogo on 11 years. Patients and Methods: This was a retrospective descriptive study of rabies cases in children who were received at CHUYO (University Hospital Center Yalgado Ouedraogo) from 1st January 2003 to 31 December 2014. The diagnosis was clinical, associated with a notion of suspect animal bite; data were collected from medical files and analyzed with Epi Info version 6. Results: During the study period, 60 rabies cases were reported, including 24 children. Children average age was 08.5 ± 4 years with a sex ratio of 07. In 47.6% of cases, children were referred from other provinces of the country and 58.3% case lived in rural areas. In all cases, the animal aggressor was a dog, and in 62.5% of cases, it was a stray dog. Upper limbs were the most common site followed by the lower limbs; nevertheless, the head represented 12.5% of the reported injuries. The main clinical signs were agitation (70.8%), hydrophobia (58.3%), and fever (50%). In 30% of cases, the parents left the hospital with their child without or against medical opinion. Conclusion: Rabies frequency is significant in children and is probably under-diagnosed because of clinical signs most often confused with other diseases. Pre-exposure prevention through vaccination is the best way to fight against rabies in children.