Safety and effectiveness of laparoscopic adult groin hernia repair in Africa: a systematic review and meta-analysis.

BACKGROUND: Surgery is the recommended treatment of groin hernia, and laparoscopic approach is increasingly accepted due to lower risk of chronic pain. This systematic review aims to evaluate results of laparoscopic groin hernia repair (LGHR) in Africa. METHODS: We performed a literature search of published studies using electronic databases. Included African articles reported at least one of outcomes after LGHR in adult population. Newcastle-Ottawa Scale was used for quality assessment. A quantitative meta-analysis was performed to estimate the pooled prevalence of the post-operative outcomes. RESULTS: We included 19 studies from 6 countries which totalized 2329 hernia cases. Mean age was 44.5 years and male patients were predominant (sex-ratio 19.8). The mean operative time was 69.1 min. The pooled prevalence of conversion to open procedure was 2.578% (95% IC: 1.209-4.443). The pooled prevalence of surgical site infection and Hematoma/Seroma was respectively 0.626% (95%IC: 0.332-1.071) and 4.617% (95% IC: 2.990-6.577). The pooled prevalence of recurrence and chronic pain was respectively 2.410% (95% IC: 1.334-3.792) and 3.180% (95% IC: 1.435-5.580). We found that total morbidity for TAPP procedure was higher than TEP procedure (p = 0.0006; OR 1.8443). CONCLUSION: These results confirm that LGHR is safe and feasible and would be recommended in our African context.

Adult groin hernia surgery in sub-Saharan Africa: a 20-year systematic review and meta-analysis.

PURPOSE: To realize a systematic review to evaluate groin hernia surgery for adults in sub-Saharan Africa. METHODS: We conducted a systematic review and meta-analysis, the primary objective of which was to determine the surgical techniques used for unilateral groin hernia surgery in sub-Saharan Africa. Studies published in the last 20 years were considered. A meta-analysis estimated the pooled prevalence with 95% confidence interval (CI) of mortality, chronic pain and recurrence. A subgroup analysis compared the rate of complications between complicated or uncomplicated hernia. RESULTS: We included 113 articles. The most used technique was Bassini in 40.1%, followed by Lichtenstein in 29.9% and Shouldice in 12.6%. The overall mortality rate was 0.6% (95% CI 0.4-0.9). The pooled recurrence rate was 1.4% (95% CI 1.05-1.9). The pooled rate of chronic pain was 2.7% (95% CI 1.9-3.7). We found that mortality rate for complicated hernias (6.4%) was higher compared to uncomplicated hernias (0.2%). This difference was statistically significant [p ≤ 0.001; OR = 47.7; 95 CI (27.2-83.47)]. CONCLUSION: This review showed that pure tissue repairs are the most used techniques with Bassini and Shouldice as leading procedures. The post-operative rates of recurrence and chronic pain are low. However, there is a high heterogeneity between studies than can underestimate these pooled prevalences. The consultation at complication stage remains frequent and associated with a higher mortality. Futures studies should focus on improving the quality of studies in terms of design and follow-up to increase the degree of evidence.

Infected urachal cyst in an adult, report of two observations.

INTRODUCTION: Urachus is an embryonic remnant that usually involutes before birth. Abnormal persistence of this structure gives embryologic malformation like an urachal cyst. Infection or malignancy degeneration can complicated it. CASE PRESENTATION: Case 1: We report 20 years old female patient consulted with acute abdominal pain. Clinical examination showed fever and infra-umbilical tender mass. The abdominal Computerized Tomography showed pelvic mass between umbilicus and bladder. The open laparotomy found infra-abdominal semi-solid mass. A complete resection was done and histological exam confirmed infected urachal cyst. Case 2: A 19 years old male patient presented with abdominal pain and fever. Physical examination found tenderness in lower abdomen. Biology revealed leukocytosis, and Ultrasonography found a heterogeneous infra-umbilical mass. Surgical exploration by mini-laparotomy found an abscess urachal cyst that is confirm by histological exam after complete resection. CLINICAL DISCUSSION: Urachal cyst in adult patient is rare. Clinical symptoms without complications are insignificant. Because of malignancy risk, adult urachal cyst are managed by surgery. CONCLUSION: Infection cyst is the most common complication of urachal cyst. Complete resection is recommended because of malignancy degeneration risk.

[Hospital Management of Work-related injuries in informal sector: case of artisanal fishing in Saint-Louis (Senegal)]. / Prise en Charge Hospitalière des accidents de Travail dans le secteur informel : cas de la pêche artisanale à Saint-Louis (Sénégal).

OBJECTIVES: to determine the mechanisms, lesions and hospital management of work-related accidentduringtraditional fishing,an activity subject to vital occupational risks. MATERIALS AND METHODS: Descriptive retrospective study on occupational injury files in artisanal fishing professions, registered at the Saint-Louis Regional Hospital (Senegal), from January 2014 to December 2019. All complete records of trauma during any activity related to artisanal fishingwereincluded. Data on accident mechanisms, injuries observed, and hospital management were collected. RESULTS: 47 male workers were on average 28.4 years old. Direct shock from a pirogue was most frequent (68.10%), followed by sharp or blunt objects (16.27%). The lesions were characterized by bone fractures in 63.83% of cases (n=30); chest-abdominal-pelvic and limb contusions and wounds represented 12.67% and 21.27% of cases, respectively. Medical management was done in 21 cases (44.7%). Surgery was dominated by intramedullary nailing in 15 cases (31.9%). Two laparotomies were performed with intestinal sutures. A chest contusion death was reported. CONCLUSION: Traumatic occupational risks in traditional fishing are life threatening. A better understanding of these risks and their consequencesmakes it possible to ensure good prevention.

OBJECTIFS: déterminer les mécanismes, les lésions et la prise en charge hospitalière des accidents de travail maritimes au cours de la pêche artisanale. MATÉRIEL ET MÉTHODES: Etude rétrospective descriptive sur les dossiers de traumatismes par accident de travail de la pêche artisanale, recensés au niveau du Centre Hospitalier Régional de Saint-Louis (Sénégal), de janvier 2014 à décembre 2019. Etaient inclus tous les dossiers complets de traumatisme au cours de toute activité liée à la pêche artisanale. Les données sur le mécanisme des accidents, les lésions constatées et la prise en charge hospitalière étaient recueillies. RÉSULTATS: il s'agissait de 47 travailleurs masculins âgés en moyenne de 28,4 ans.Les chocs directs par une pirogue étaient les plus fréquents (68,10%), suivis des objets tranchants ou contondants (16,27%). Les fractures étaient prédominantes dans 63,83% des cas (n=30) ; les contusions thoraco-abdomino-pelviennes et de membres ainsi que les plaies représentaient respectivement 12,67% et 21,27% des cas. Le traitement était médical dans 21 cas (44,7%). La chirurgie était dominée par l'enclouage centro-médullaire dans 15 cas (31,9%). Deux laparotomiesétaient effectuées avec sutures intestinales. Un décès par contusion thoracique était noté. CONCLUSION: les risques professionnels traumatiques dans la pêche artisanale engagent le pronostic vital. Une meilleure connaissance de ces risques par les travailleurs permet d'en assurer une bonne prévention.

Factors Associated with Foot Lesions in Diabetic Patients at Saint-Louis Hospital (Senegal): A Case-Control Study Protocol.

INTRODUCTION: Diabetes prevalence has increased over the past years. In Senegal, this prevalence is 4% in the general population. However, the region of Saint-Louis (in the north of the country) has the highest rate with 10.4%. The main prognosis problem is the occurrence foot lesions that can lead to lower-limbs amputation. Diabetic foot is a real public health issue, due to its economic burden and its serious repercussions on patients, leading to poor quality of life. The objective of this case-control study is to identify factors associated with foot lesions in diabetic patients. METHODS AND ANALYSIS: It will be a case-control study from January to December 2021. The patients will be recruited from the departments of general surgery, internal medicine, and emergency. An univariate then multivariate analysis (logistic regression) will allow us to select the variables associated with foot lesions in our study population. The parameters included in the logistic regression will be those with a p < 0.20 in the univariate analysis. Finally, a binary logistic regression analysis (with the calculation of Odds Ratios (OR) with confidence intervals (CI)) according to the backward stepwise method will identify the factors independently associated to foot lesions in diabetic patients. ETHICS AND DISSEMINATION: This research protocol will be submitted to the Ethics Committee of our institution for approval. The knowledge of factors causing diabetic foot will help to communicate with policymakers to raise the awareness in our community. Finally, it will help to prevent lower limb amputations. HIGHLIGHTS: Diabetes is the leading cause of non-traumatic lower-limb amputation in the world.The region of Saint-Louis (Senegal) has the highest prevalence of diabetes.Controlling factors associated with foot lesions in diabetic patients can prevent from amputation.

Profile of Patients with Gallstone Disease in a Sub-Saharan African General Surgery Department: A Retrospective Cohort Study Protocol.

INTRODUCTION: Gallstone disease is a disorder characterised by the formation of stones in the biliary tract. It is the most common biliary condition accounting for more than 98% of all gallbladder and biliary tract disorders. In Africa, previous studies have shown a relative rarity of this condition with a prevalence less than 5%; since it is between 2 and 5 times higher in other continents. A good knowledge of the profile of patient with gallstone disease in a surgical setting could allow to reduce gallstone disease complications and to tailor better the treatment. To our knowledge, there was no previous study about gallstone disease in this region even if there is a high prevalence of metabolic factors of gallstone disease. METHODS: This study objective is to describe the epidemiological, diagnostic and therapeutic profile of patients with gallstone disease at the Department of General Surgery of Saint-Louis Hospital (Senegal). It will be a single-centre retrospective cohort study in a period of 5 years (January 2015 - December 2020). The patients' record of the department of general surgery will be consulted and the patient contacted if there are missing data. Patients with gallstone disease diagnosed with imaging (ultrasonography and/or CT scan) regardless the presentation (asymptomatic, biliary colic, cholecystitis, common bile duct lithiasis, angio-cholitis, pancreatitis) will be included. Adults and paediatric patients will be enrolled. Patient records lacking sufficient data will be excluded. Studied parameters will be epidemiological, clinical, paraclinical and therapeutic aspects. ETHICS AND DISSEMINATION: Anonymity and confidentiality of information collected in patients will be respected. This research protocol will be submitted to the Ethics Committee of our institution for approval. The knowledge of the profile of patients with gallstone disease in a surgical setting could allow to reduce gallstone disease complications and to tailor better the treatment. Finally, it will help to reduce the burden of gallstone disease. HIGHLIGHTS: Gallstone disease is the most common biliary tract conditionTo our knowledge, there was no previous study about gallstone disease in this region even if there is a high prevalence of risk factors of gallstone disease (sickle cell disease, diabetes, obesity, hypercholesterolemia)Good knowledge of the profile of patients with gallstone disease in a surgical setting could allow to reduce gallstone disease complications and to tailor better the treatment.

HIV-exposed uninfected compared with unexposed infants show the presence of leucocytes, lower lactoferrin levels and antimicrobial-resistant micro-organisms in the stool.

Background: HIV-exposed uninfected (HEU)-infants have been shown to be particularly vulnerable to infections. In this population, disturbance of the gut micro-environment might increase their susceptibility to enteric diseases and even favour the translocation of bacteria in the bloodstream. Methods: The gastro-intestinal micro-environment was explored in 22 HEU infants and 16 HIV-unexposed (HU) infants aged 6-24 weeks. Faecal leucocytes, firmicutes (gram-positive bacteria) and gracilicutes (gram-negative bacteria) were assessed by cytology. Faecal lactoferrin and sIgA were measured by ELISA. The spectrum of micro-organisms in infants' stool was analysed by culturing. Results: HEU infants were 14 times more likely to have leucocytes in their stool than HU infants (p < 0.005). The lactoferrin level was significantly lower in HEU infants than in HU infants (p = 0.02). Potentially pathogenic bacteria such as Escherichia coli were more prevalent in HEU than in HU infants (64% vs 23.5%). Also, E. coli strains resistant to key antibiotics including co-trimoxazole, ß-lactam (cephalosporins included) and tetraclines were observed in some HEU infants. Conclusion: HEU infants are more likely to present an inflamed digestive tract as highlighted by the presence of leucocytes. In addition, there is a real risk of colonisation of HEU infants' microbiota by resistant micro-organisms.

Malaria vector population dynamics in highland and lowland regions of western Kenya.

BACKGROUND & OBJECTIVES: Malaria is the major cause of morbidity and mortality in sub-Saharan Africa. A child below five years dies after every 30 min. Highland areas under land use change impact on malaria transmission by altering the microclimate of the immature stages and adult mosquitoes. Adult vector population dynamics is important because it is an indicator of transmission risk of the disease. This study was to investigate the effects of microclimatic changes on the mosquito indoor-resting behavior. METHODS: The study was conducted at a highland site of Marani and at a lowland site of Kombewa where 30 houses were randomly selected at either site. Outdoor and indoor weather conditions were monitored throughout the study period. Indoor mosquitoes were collected using the pyrethrum spray catch method, gonotrophic stage of the females determined and species identified to species level using rDNA polymerase chain reaction method. ELISA was carried out to determine the Plasmodium sporozoites in mosquitoes. RESULTS: Anopheles gambiae s.s. was more abundant at the highland site whereas An. funestus at the lowland site. Indoor densities were highest in June 2003 at both the sites: An. gambiae at the highland site and An. funestus at the lowland site. There was an association between An. gambiae s.s. abundance and relative humidity at the highland site. Combined entomological inoculation rate (EIR) for both the vector species was 0.4 infected bite per year (ib/yr) at the highland site and 31.1 ib/yr at the lowland site. Prolonged indoor spraying with insecticide decreased vector indoor abundance.

Effect of swamp cultivation on distribution of anopheline larval habitats in Western Kenya.

BACKGROUND & OBJECTIVES: Malaria resurgence in highland regions of East Africa has been on increase. The spatio-temporal distribution of larval habitats of malaria vectors determines the distribution of adult vectors, hence, disease transmission. Vector's ecology is necessary for strategic vector control through effective plan for source reduction. Mapping of the larval habitats is necessary for targeted control measures. The purpose of this study is to assess and compare the spatial and seasonal variations in anopheline larval habitats in Western Kenya. METHODS: A comparative study was conducted on spatial distribution of GPS geo-located anopheline larval habitats in relation to highland and lowland environments. Land use types were categorized and all potential aquatic habitats of malaria vectors were examined in February, May, August and November 2004. Data analyses were performed using SAS JMP software. RESULTS & DISCUSSION: Results showed a higher percentage of Anopheles gambiae s.s. (70.9%) than An. funestus (29.1%) in highland. In the lowland, An. gambiae s.l. comprised 60.1% while An. funestus represented 39.9%. The distribution of larval breeding is confined to the valley bottom in the highland while it was dispersed in the lowland. Land use type influenced the occurrence of positive breeding habitats in the highland. In the lowland, distribution was due to seasonality. We found high proportion of potential and positive breeding sites in cultivated swamps and farmlands at the highland site. These results suggest that swamp cultivation increases the availability and suitability of larval breeding habitats of malaria vectors, thus malaria transmission in the Western Kenya highlands environment.