Importance of vector-borne infections in different production systems: bovine trypanosomosis and the innovation dynamics of livestock producers in Senegal.

In Senegal, a project has been undertaken to eradicate a population of tsetse flies (Glossina palpalis gambiensis) from a prime area for intensifying livestock production--the coastal region of Niayes. The project is intended to remove the constraint of trypanosomosis and allow the ecological intensification of cattle production. A cross-sectional analysis of ten case studies was the inductive phase of an assessment to gauge the impact of removing trypanosomosis on livestock production strategies. The methodology used was comprehensive analysis, with participatory epidemiology tools to understand farmers' rationales. The authors analysed the strategies of three main types of livestock producer (agro-pastoralists, mixed crop/livestock farmers and intensive dairy farmers). The strategies were in line with the farmers' goals and their ability to mobilise the socio-technical network. The risk management of trypanosomosis has been incorporated into livestock management practices through the use of trypanotolerant breeds, medical prophylaxis or placing livestock in low-risk areas. Removing the risk of disease would therefore have a major impact on decisions about the composition and strategic direction of herds. This change in the animal health environment would steer livestock production along different routes of intensification in a highly competitive environment. The indicators of innovation capacity revealed by this study will be used to quantitatively monitor various change scenarios, taking livestock producers' reasoning into account, in order to assess the socio-economic impact of eradicating the tsetse fly population in this area. The methodology presented in the study can be used to understand the impact of controlling other vector-borne infections on the innovation dynamics of livestock producers.

[Mortality and morbidity of tetanus in the infectious diseases department, Point G teaching hospital, in Bamako, Mali (2004-2009)]. / Morbidité et mortalité du tétanos dans le service de maladies infectieuses du CHU du Point G à Bamako, Mali (2004-2009).

Our study objectives were to determine annual cases of the tetanus and to describe its clinical, evolutionary and prognostic aspects. It was a transverse study from data records and medical records of patients aged 15 years and above hospitalized for tetanus in the service of infectious diseases of the Point G CHU from January 1, 2004 to December 31, 2009. The tetanus was diagnosed based on clinical (trismus, dysphagia, seizures and point consecutive to an injury) and epidemiological arguments (absence of a correct tetanus immunization, entry way). We collected a total of 119 cases of tetanus out of 1,839 hospitalizations making a prevalence of 6.5%. The hospitalization period was 5 days (73%) for most of the patients. Unskilled laborer and farmers were the most frequent with respectively 30.2 and 21.8% of cases. Tetanus occurred in the course of a traumatic road accident (16%) and from other traumatic causes (48.7%). The clinical form was a generalized type for 94.4% of the cases. A wound was the entry way for 64.7% of the patients. The entry way was located on the lower members 49.6% of the time. The co-morbidity was recorded with infection by Plasmodium falciparum (15 cases, 12.6%) and HIV (1 case). Hospital lethality was 46.2%. The death was statistically linked to clinical severity according to the Dakar score (P = 0.0005) and the Mollaret stage (P = 0.0001). A need for strengthening communication for behaviour change for the gaining of a correct and sustained immunization exists. A strategy based on the capacity building for a rapid tetanus diagnosis and a combined co-morbidities care may reduce the lethality in the context of our limited technical environment.

The prevalence of African animal trypanosomoses and tsetse presence in Western Senegal.

In 2005, the Government of Senegal initiated a tsetse eradication campaign in the Niayes and La Petite Côte aiming at the removal of African Animal Trypanosomosis (AAT), which is one of the main constraints to the development of more effective cattle production systems. The target area has particular meteorological and ecological characteristics that provide great potential for animal production, but it is unfortunately still infested by the riverine tsetse species Glossina palpalis gambiensis Vanderplank (Diptera: Glossinidae). The tsetse project in Senegal has adopted an area-wide integrated pest management (AW-IPM) approach that targets the entire tsetse population within a delimited area. During the first phase of the programme, a feasibility study was conducted that included the collection of entomological, veterinary, population genetics, environmental and socioeconomic baseline data. This paper presents the parasitological and serological prevalence data of AAT in cattle residing inside and outside the tsetse-infested areas of the target zone prior to the control effort. At the herd level, a mean parasitological prevalence of 2.4% was observed, whereas a serological prevalence of 28.7%, 4.4%, and 0.3% was obtained for Trypanosoma vivax, T. congolense and T. brucei brucei, respectively. The observed infection risk was 3 times higher for T. congolense and T. vivax in the tsetse-infested than in the assumed tsetse-free areas. Moreover, AAT prevalence decreased significantly with distance from the nearest tsetse captured which indicated that cyclical transmission of the parasites by tsetse was predominant over mechanical transmission by numerous other biting flies present. The importance of these results for the development of a control strategy for the planned AW-IPM campaign is discussed.

[Perioperative management of laparoscopic cholecystectomy in children with homozygous sickle cell disease]. / Prise en charge périopératoire de la cholécystectomie par voie laparoscopique chez l'enfant drépanocytaire homozygote.

OBJECTIVE: Sickle cell disease is a public health problem in Africa. The aim of this prospective study was to evaluate per and post-operative complications of laparoscopic cholecystectomy in sickle cell children in Senegal. METHODS: from January 1999 to December 2006, an anesthetic protocol was applied to 39 sickle cell children undergoing a cholecystectomy. Among them, 20 experienced laparoscopic cholecystectomy. RESULTS: All these 20 patients had previously suffered from sickle cell visceral complications and were classified as ASA II (11 cases) and as ASA III (9 cases). Blood transfusion program aimed at sustaining haemoglobin level between 10 and 12 g/dl was implemented. The preoperative monitoring and anesthesia management were the same for these patients. During perioperative period, the prevention of pain, hypovolemia, hypothermia and acidosis was achieved. The mean insufflation duration of laparoscopy was 23 min (17-60 min), the mean surgery duration was 55 min (40-110 min), and the mean anesthesia duration was 78 min (88-135 min). Postoperative complications occurred in 9 patients: acute chest syndrome (n=2), postoperative hemolysis (n=5), vaso-occlusive crisis (n=2). CONCLUSION: Laparoscopic cholecystectomy can be carried out in sickle cell children affected with gallstones, provided that general anaesthetic rules were respected. An appropriate pre-, per- and postoperative anaesthesia is mandatory to reduce postoperative complications in children with sickle cell disease. Searching for early diagnosis of gallstones before occurrence of visceral complications should allow further optimal laparoscopic surgery.

[Nosocomial infections: definition, frequence and risk factors]. / Les infections nosocomiales: définition, fréquence et facteurs de risque.

Infection is nosocomial if it missed at the time patient admission in the health establishment. When infectious status of the patient on admission is unknown, infection is generally regarded as nosocomial if it appears after a time of at least 48 hours of hospitalization. For surgical site infection, the commonly allowed time is 30 days, or, in case of prosthesis or an implant, one year after surgical intervention. Nosocomial infections (NI) constitute major health care problem from their frequency, their cost, their gravity. Mortality related to NI can attempt 70% in certain units like intensive care units. Two ways of contamination are possible: the endogenous way is responsible of majority of hospital infections. The normally sterile sites are contaminated then colonized by the flora which is carrying the patient himself, with the favor of a rupture of the barriers of defense. The exogenic way is associated colonization, possibly followed by infection, of the patient by external bacteria, coming from others patients or from environment, transmitted in an indirect way (aerosols, manuportage, materials). Whatever its mode of transmission, apparition of nosocomial infection can be related to several supporting factors: age and pathology, certain treatments (antibiotic which unbalance patients' flora and select resistant bacteria, immunosuppressive treatments), invasive practices necessary to the patient treatment. The prevalence of nosocomial infections is higher in the intensive care units where certain studies bring back rates of 42.8% versus 12.1% in others services. The four sites of nosocomial infection most frequently concerned are: the respiratory site, urinary infections, bloodstream infections (Catheters related bloodstream infections in particular), and surgical sites infections. The relative proportion of these infections varies according to principal activity of the unity.

[Severe thrombocytopenic thrombotic purpura and pregnancy: a case report]. / Purpura thrombotique thrombocytopénique grave et grossesse: a propos d'un cas.

INTRODUCTION: Thrombotic thrombocytopenic purpura failure (TTP) is a micro angiopathy caracterized in its severe form by multivisceral involement and early death. The association with pregnancy is rare, the diagnosis is difficult, but imperative because that will allow an early specific management and will improve the diagnosis CASE: Our patient is a 25 years old woman admitted in intensive care unit after cesarian section for eclampsia at term. Clinical and biological assessement were in favor at Hellp syndrome. Toxemia complicated with eclampsia and Hell syndrome was the final diagnosis and appropriate treatment followed. However the treatment, diffuse purpuric petechia appeared associated with jaundice, thrombocytopenia. The diagnosis of T.T.P was considered and corticotherapy started at day 8. Patient responded within 48 h and healins was complete after 5 weeks. CONCLUSION: Authors emphasized on the importance of the diagnosis and specific management.

[Management of thermal severe burns in children in Le Dantec University Teaching Hospital]. / Prise en charge des brûlures thermiques Graves de l'Enfant au CHU le Dantec.

INTRODUCTION: Bums in children are serious public health problem. Burns management in developing countries encounters huge problems at any stage. The goals of this study were to descrive the epidemiological, clinical and therapeutic characterics. MATERIALS AND METHODS: In the university Teaching Hospital of Dakar from January to December 2003, we conducted a retrospective survey of 41 patients less than 16 years admitted for severe thermal burns. We carried a year retrospective study in ICU and pediatric surgery unit of Aristide Le Dantec Hospital. Were involved all. The following parameters were studied: age, sex, mechanism and circumstances of the burns, period time between the injury and the admission, clinical status of the patient, management and outcome. RESULTS: The age range between 5 days and 13 years, 47.72% are less than 3 years. The average period before admission was 33 hours (2 hours to 7 days). The accident occurs in 75% of cases in the kitchen. Bum by hot water was the most frequent mechanism with a percentage of 62%. Areas interested the whole body with frequent face localisation (n=18) and the perineal region (n=22). Immediate complications were shock in 37% of children and acute respiratory failure in 7 patients. Fluids and electrolytes resuscitation using Parkland formula (75%) or Carvajal formula (25%). Feeding was done to enteral route. Spontaneous epitheliasation through secondary heeling was the main therapeutic attitude, skin grafting was performed in 10 childrens. Total mortality was 18.18%; These death concerns patients for whom the UBS score range between 75 and 140 UB and the ABSI score between 9 and 12. Sepsis was the direct main cause of death. Sequellaes were jointed a nd facial contractures. CONCLUSION: The authors emphasize on the need in setting up adequate preventive measures towards high risk population (under 3 years), and specialized unit for adapted management.

[The para-umbilical block in children: 75 cases report]. / Le bloc para-ombilical chez l'enfant: a propos de 75 cas.

The objective of this study is to assess both intra and post operative analgesia in infants undergoing umbilical hernia repair under general anaesthesia with neither opioid nor muscle relaxant, associated with a para umbilical block. It's a prospective study covering a 15 months period. The study included 75 infants (age = 5 months - 13 years; body weith = 6 kg - 35 kg). General anaesthesia was induced with either thiopentone or halothane and, maintained with halothane in a N2O - O2 50 VOL % mixture. Para-umbilical block was obtained using 1 ml/kg of 0.25% marcaïne. Pain was assessed using time course of respiratory rate, heart rate and mean arterial pressure. A change of more than 20% in one of these variables was considered criterion of poor analgesia. Intraoperative analgesia was adequate in all patients but four, 5 minutes after incision. Surgical conditions were considered as being godd or satisfactory in 90.6% and 9.4% of cases, respectively. Post operative analgesia, assessed 1 and 6 hours after completion of surgery was convenient in 93.3% of infants. The block appears as simple, most after efficient and safe in umbilical surgery.

[Intensive care management of 28 patients with severe eclampsia in a tropical African setting]. / Prise en charge de l'éclampsie grave en réanimation en milieu tropical africain. A propos de 28 cas.

OBJECTIVE: To study the specific management problems of severe eclampsia under tropical latitudes. STUDY DESIGN: A two years retrospective study in a University hospital in the tropics. PATIENTS AND METHODS: In all patients admitted for eclampsia between January 1997 et December 1999, the following parameters were studied: age, parity, interval between disease et admission, post-eclampsia Glasgow Coma Scale (GCS), time of occurrence of eclampsia during pregnancy, delivery route, blood pressure data at admission, the occurrence of complications at admission or during hospital stay. RESULTS: Twenty-eight mainly primiparous patients (mean age: 26 +/- 6) were admitted with an average delay of 8.5 +/- 10.2 hours after the first symptoms. The time of occurrence was prepartum in 6, perpartum in 14 and postpartum in 8 cases. All patients were hypertensive and comatose with an average GCS of 8 +/- 2.2. Twenty patients had been previously intubated and ventilated. Delivery was natural in 22 and by caesarean section in 6 patients. The following complications were found: acute oliguric renal failure (9), HELLP-syndrome (4), cerebral haemorrhage (4), acute lung oedema (3) and acute respiratory distress syndrome (1). Maternal and child mortality were 35 and 42.8% respectively. CONCLUSION: Eclampsia is a major cause of both maternal and infantile mortality in developing countries. The authors insist that prevention and management require speedy transfers to adapted specialized obstetrical intensive care structures.

[Assessment of the management of polytrauma patients at Le Dantec Hospital, Dakar]. / Evaluation de la prise en charge des polytraumatisés au CHU Le Dantec de Dakar.

Traumatisms represent the first reason of death in people less than 40 years in the developed countries. In Senegal, with the growth of urbanization, road accidents are more and more frequent and mortality by polytrauma is raised. The aim of this study was to evaluate the management of polytrauma patients in our hospital and to determine factors of mortality. This prospective study was carried out from January to June 2000 at the surgical emergencies department and the intensive care unit in Le Dantec Teaching Hospital of Dakar. One hundred and six polytrauma patients were taken care of during the study period. The mean age of patients was 30 years. There were 85 men and 21 women. Circumstances of trauma were dominated by road accidents (74.5%) and in 77.4% of cases patients were evacuated without prehospital care. The mean delay from the accident to the arrival at emergencies was 8 hours. Half of the patients presented to the admission a clinical picture of circulatory failure; respiratory distress was also present among 50% of patients and 53.8% of patients had a serious head injury with a Glasgow coma scale lower than 8. The global mortality was 69.8% and 80.6% of these deaths were attributable to serious head injury. Management of trauma patients in Dakar could be improved by setting up a medical transport system and by the improvement of the technical means in the hospitals. These measures, in combination with the prevention of road accidents, will surely allow to reduce the number of accidents, polytrauma and deaths.

[Anesthesia in the pleuropulmonary complications surgery of tuberculosis: a 79 cases study]. / Anesthésie-Reanimation dans la chirurgie des complications pleuropulmonaires de la tuberculose: a propos de 79 cas.

Reported is a retrospective study carried out from Aristide Le Dantec Hospital in patients who underwent pleuropulmonary surgery after tuberculosis complication, from June 1995 to June 1999. The aim of this study was to evaluate the anaesthesiology procedures and outcomes of tuberculosis pleuropulmonary complications surgery. Seventy nine patients were studied. Their mean age was 34.63 years, and the sex ratio was 3.14. They all underwent general anaesthesia procedures with barbituric, morphinics et myorelaxants drugs. The peroperative complications noted were distributed as follow: 50 cases of haemorrhage needing transfusion, 18 cases of hypotension associated to the anaesthesia. In the intensive care period, we have noticed 30 atelectasia cases associated to a spastic bronchopathy, 3 cases of pulmonary oedema and 1 case of pulmonary infarctus. In the postoperative period, 8 cases of hemodynamic instability occurred, including 5 cases of cardiovascular collapsus treated by filling, and 2 septic shocks cases. An infectious bronchopneumopathy was noticed on 11 patients with two cases of septicaemia. The mortality rate was 6.3% (5 cases of death). The pleuropulmonary surgery in tuberculosis complication is very haemorrhagic, and therefore require an adequate preoperative preparation.

[Anesthesia in the surgery of hyperthyroidism at Le Dantec Teaching Hospital]. / Anesthésie dans la chirurgie de l'hyperthyroïdie au CHU Le Dantec.

Authors report a study of 66 patients admitted to the clinic ORL of CHU Le Dantec between 1991 and 2000 for goiter and hyperthyroidism. They evaluate the perioperative management and underline the importance of the medical preparation. The age of patients varied between 15 and 74 years. There were 62 women and 4 men. Fifty three patients presented clinical and biological hyperthyroidism. Thirteen patients had functional hyperthyroidism without clinical signs of thyrotoxicosis. Exophthalmia was present in 20 patients. Twenty one patients have been addressed to the Internal Medicine service for preoperative management of hyperthyroidism. Forty five patients have been operated under general anaesthesia. The medical preparation comprised antithyroid drugs and beta-blockers. We found as complications 3 cases of difficult intubation, 7 cases of peroperative haemorrhage and 1 case of acute thyroid crisis. The anaesthesia for surgery of hyperthyroidism is currently well codified and operative outcome became simple. The medical preparation in case of hyperthyroidism allows to return the patient in euthyroidism and reduces considerably the acute thyroid crisis risk, the most fearsome complication and the most feared of the hyperthyroidism.

[Acquired bacteraemias at the intensive care unit]. / Bactériémies acquises dans un service de réanimation.

Acquired bacteraemias in intensive care unit (ICU) have some serious consequences in terms of morbidity, mortality and costs. The emergence of multiresistant germs in ICUs, and the therapeutic difficulties that ensue, participate in the aggravation of the prognosis of these infections. The aim of this work was to study the epidemiological aspects of acquired bacteraemias in ICU and the responsible germs sensitivity, to determine strategies of adequate antimicrobial treatment. During the period of study, 31 positive blood cultures collected from 19 patients were considered to be true bacteraemias, giving an incidence rate of 6.3 for 100 admissions. The mean age of our patients was 27.7 years old. There were 16 men and 3 women. Traumatology was the underlying pathology in 52.63% of cases. The origin of the infection was unknown in 84.2%. Flavobacterium spp was the most frequent germ (42%), followed by Pseudomonas aeruginosa (26.2%), and Staphylococcus negative coagulase (10.6%). Only one anaerobic germ was isolated. Flavobacterium spp and Pseudomonas aeruginosa were in general sensitive to most antibiotics used with the exception of aminosides. Staphylococci negative coagulase were methi - resistant. The sensitivity of the anaerobic germ was not tested. The antimicrobial treatment was adapted in 84.2% of cases; the association ciprofloxacine-cefotaxime could be a good alternative in serious infections to Gram negative bacteria. The global death rate among our patients was 42%. The death was directly related to bactereamia in only 15.3% of cases. The existing committee for nosocomial infections control should be more effective in our hospital. The role of this committee is to carry out microbiological surveillance, to recommand and make sure of the application of preventive measures against nosocomial infections, to promote the accessibility of antibiotics such as imipeneme, aztreonam, ceftazidime, vancomycine...., and to propose an appropriate antimicrobial treatment strategy; these measures could reduce notably the morbidity and mortality related to nosocomial infections in general and bactereamias in particular.