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1.
World J Surg ; 48(5): 1056-1065, 2024 05.
Artigo em Inglês | MEDLINE | ID: mdl-38491816

RESUMO

BACKGROUND: Most low- and middle-income countries do not have a mature prehospital system limiting access to definitive care. This study sought to describe the current state of the prehospital system in Senegal and offer recommendations aimed at improving system capacity and population access to definitive care. METHODS: Structured interviews were conducted with key informants in various regions throughout the country using qualitative and quantitative techniques. A standardized questionnaire was generated using needs assessment forms and system frameworks. Descriptive statistics were performed for quantitative data analysis, and qualitative data was consolidated and presented using ATLAS.ti. RESULTS: Two (20%) of the studied regions, Dakar and Saint-Louis, had a mature prehospital system in place, including dispatch centers and teams of trained personnel utilizing equipped ambulances. 80% of the studied regions lacked an established prehospital system. The vast majority of the population relied on the fire department for transport to a healthcare facility. The ambulances in rural regions were not part of a formal prehospital system, were not equipped with life-support supplies, and were limited to inter-facility transfers. CONCLUSIONS: While Dakar and Saint-Louis have mature prehospital systems, the rest of the country is served by the fire department. There are significant opportunities to further strengthen the prehospital system in rural Senegal by training the fire department in basic life support and first aid, maintaining cost efficiency, and building on existing national resources. This has the potential to significantly improve access to definitive care and outcomes of emergent illness in the Senegalese community.


Assuntos
Serviços Médicos de Emergência , Acessibilidade aos Serviços de Saúde , Senegal , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Serviços Médicos de Emergência/organização & administração , Inquéritos e Questionários
2.
Radiol Case Rep ; 19(7): 2895-2897, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38706814

RESUMO

Posterior Reversible Encephalopathy Syndrome (PRES) is a radio-clinical entity associating reversible damage of the central nervous system and typical brain imaging. The clinical context is often suggestive with, in half of cases, the use of vasoactive substances (cannabis, antidepressants, nasal decongestants) and/or postpartum. The etiologies are dominated by hypertensive encephalopathy, preeclampsia, eclampsia, immunosuppressive therapies, and systemic diseases. We report a case of posterior encephalopathy syndrome occurring in a young female without hypertension. It was about a 40-year-old female without hypertension underlying condition, received at the emergency department for headaches and generalized tonic-clonic seizures. The physical examination was unremarkable, and her blood pressure was 130/70 mm Hg. CT scan revealed bilateral white matter hypodensity in the posterior occipital regions and a right frontal subarachnoid hemorrhage. There was no aneurysmal malformation of the polygon of Willis and no cerebral thrombophlebitis. Brain MRI showed T2 and FLAIR hypersignal areas in the occipital and frontal cortico-subcortical regions, with no diffusion signal abnormalities or contrast enhancement, and a right frontal subarachnoid hemorrhagic lesion with no other impairment. The diagnosis of reversible posterior encephalopathy syndrome was made up, and the outcome was favorable under treatment. Posterior reversible encephalopathy syndrome is an uncommon but probably underdiagnosed condition. Hypertensive encephalopathy is the most common etiology. However, there would be cases of PRES without hypertension as shown in this observation.

3.
Radiol Case Rep ; 18(12): 4458-4460, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37860781

RESUMO

Cerebral amyloid angiopathy (CAA) is an age-related cerebral microangiopathy characterized by the accumulation of amyloid-beta peptide in the wall of leptomeningeal arteries and cortical vessels. Diagnosis of sporadic amyloid angiopathy is most often made in elderly patient with lobar hematoma. We report a case of a 68-year-old female who had minimal head injury. Cerebral CT showed a right cerebellar hematoma. Follow-up MRI after 4 months showed signs of cerebral amyloid angiopathy. Through this observation, we describe the MRI semiology that helps make the diagnosis of cerebral amyloid angiopathy.

4.
Ann Med Surg (Lond) ; 75: 103308, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35198179

RESUMO

BACKGROUND: Liver abscess is a common cause of intra-abdominal infection and its treatment depends on the presentation. Laparoscopy, in addition to its classic benefits, has particular advantages in the management of liver abscess but its role is not well defined and studies done in that field are heterogenous. The objective of this systematic review is to evaluate the efficacy of laparoscopic surgery in the management of liver abscess. METHODS: We realized a systematic review and meta-analysis including studies published in the 20 last years. The primary outcome was the pooled prevalence of recurrent or residual liver abscess after laparoscopic treatment. RESULTS: We retrieved 190 studies regarding laparoscopic surgery in liver abscess and 17 studies were included in the quantitative and qualitative synthesis. A total of 608 patients was included and 299 of them (49.1%) were treated by laparoscopic surgery. The indications were mainly failure of first line treatment (antibiotic treatment and/or percutaneous drainage and/or needle aspiration) and ruptured multiloculated, or caudate lobe liver abscess. The surgical gesture performed was laparoscopic drainage in all studies. The post-operative rate of recurrent or residual liver abscess after treatment by laparoscopy was 4.22% (95% CI: 2.29-7.07). CONCLUSIONS: This systematic review showed that laparoscopic drainage had a considerable place in the management. The post-operative rate of recurrence was low with no mortality suggesting that laparoscopy is safe and feasible for liver abscess management.

5.
Trauma Case Rep ; 42: 100708, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36210919

RESUMO

Introduction: The management of abdominal penetrating trauma remains complex. Between the risk of negative laparotomy and missed visceral injury, laparoscopy is a good alternative. We report 2 cases of abdominal penetrating trauma with colonic injury diagnosed and treated with laparoscopic approach. Observations: The first patient was 15 years old, with no medical history and received at 3 h of a penetrating trauma by stabbing. Hemodynamic status was normal. An exploratory laparoscopy was performed. It objectified a penetration of the peritoneum on the left flank with an injury of the anti-mesenteric edge of the descending colon that was sutured. The second patient was 20 years old, with no history, who had a penetrating trauma of the left iliac fossa by stabbing. Arterial pressure was normal. He was received 6 h after the trauma. An exploratory laparoscopy objectified an injury of 2 cm located at the sigmoid colon which was sutured with a good evolution. Conclusion: Laparoscopy in abdominal wounds is a good option in selected patients. It has a diagnostic and therapeutic importance in colonic injuries. The limits are represented by the possibility of unrecognized visceral lesions that can lead to additional morbidity.

6.
Pan Afr Med J ; 36: 181, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32952825

RESUMO

Vulvar cancer has been rarely reported in the literature. In young women, it is most often caused by human papillomavirus (HPV), whereas in postmenopausal women, in whom this cancer is more common, it would be caused by estrogen deficiency. Moreover, HIV infection increases the risk of developing vulvar cancer in HIV-positive women as a consequence of the high prevalence of HPV infection in these subjects. Thus, in patients with suspected vulva lesion, biopsy followed by anatomo-pathological examination should be performed in order to establish the diagnosis. We here report a case of vulvar squamous cell carcinoma in a HIV-1-positive patient with first-line antiretroviral therapy (ARV) failure.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Carcinoma de Células Escamosas/diagnóstico , Infecções por HIV/complicações , Neoplasias Vulvares/diagnóstico , Biópsia , Carcinoma de Células Escamosas/patologia , Feminino , Infecções por HIV/tratamento farmacológico , HIV-1/isolamento & purificação , Humanos , Pessoa de Meia-Idade , Falha de Tratamento , Neoplasias Vulvares/patologia
7.
Pan Afr Med J ; 28: 96, 2017.
Artigo em Francês | MEDLINE | ID: mdl-29255566

RESUMO

INTRODUCTION: Safety checklist (CL) in the operating block is a quality tool which allows to reduce perioperative morbidity and mortality. That is one of the French National Health Authority requirements for the certification procedure of healthcare institutions. This study aimed to conduct a quantitative and qualitative evaluation of the use of this tool in the central operating block at the Regional Medical Center in Saint Louis. METHODS: A prospective evaluation of the indicators for monitoring the practical use of the checklist and the contribution to the improvement of surgical practices in the operating block at the Regional Medical Center in Saint Louis was initiated since the launch of this study in March 2016. RESULTS: CL utilization rate was 75%, compliance rate was 60%; information rate was 99% for the pre-induction items, 93% for the pre-incision items and 88% for the postoperative items. Only 73% of analyzed CL were filled with an effective oral communication according to the three items. CL helped to detect hardware failures and/or adverse events in 15% of cases. No patient's identification or operated side error were objectified in our study. CONCLUSION: CL contributes in the development of the culture of patient's safety in the operating block and has led to the establishment of a risk mapping in the operating block. Nevertheless, while important, it shouldn't be considered a magic tool to avoid errors but integrated into the improvement in health care quality with other programs such as the reporting of adverse events and the the review of morbidity and mortality.


Assuntos
Lista de Checagem , Erros Médicos/prevenção & controle , Salas Cirúrgicas/normas , Complicações Pós-Operatórias/prevenção & controle , Comunicação , Falha de Equipamento , Estudos de Viabilidade , Humanos , Segurança do Paciente , Estudos Prospectivos , Senegal
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