Improving the quality of vascular surgical discharge planning in a hub centre.

Introduction Discharge planning improves patient outcomes, reduces hospital stay and readmission rates, and should involve a multidisciplinary team (MDT) approach. The efficacy of MDT meetings in discharge planning was examined, as well as reasons for delayed discharge among vascular surgical inpatients. Methods Dedicated weekly MDT meetings were held on the vascular ward in Royal Derby Hospital for three months. Each patient was presented to the discharge planning meeting and an expected date of discharge was decided prospectively. Patients who were discharged after this date were considered 'delayed' and reasons for delay were explored at the next meeting. Results Overall, 193 patients were included in the study. Of these, 42 patients (22%) had a delayed discharge while 29 (15%) had an early discharge. The main reasons for delay were awaiting beds (30%), social (14%) and medical (45%). In 64%, the cause for delay was avoidable. Two-thirds (67%) of all delays were >24 hours. This totalled 115 bed days, of which 67 could have been avoided. However, 32 bed days were saved by early discharge. This equates to a net loss of 35 bed days, at a net cost of £2,936 per month or £35,235 per year. The MDT meetings also improved the quality of discharge planning; the variability between expected and actual discharge dates decreased after the first month. Conclusions Discharge planning meetings help prepare for patient discharge and are most effective with multidisciplinary input. The majority of delayed discharges from hospital are preventable. The main causes are awaiting transfers, social services input and medical reasons (eg falls). There is an obvious financial incentive to improve discharge planning. The efficiency of the MDT at discharge planning improves with time and this should therefore be continued for best results.

[The "Health system delay" in tuberculosis patients in Saint-Louis Senegal]. / Évaluation du "health system delay" chez les patients tuberculeux à Saint-Louis du Sénégal.

Sixty patients with positive acid fast bacilli sputum smears between were enrolled consecutively between March and August 2012 in the Saint-Louis (Senegal) health district to determine the Health System Delay in response to tuberculosis. The length of time between the first consultation of a TB patient and the start of treatment was, on average, 8.1 days and is among the shortest in the literature. This promptness reduces the risk of infection related to delayed care. This is one of the focuses of the National Programme of Fight against nosocomial infections in Senegal (PRONALIN), as well as the implementation of environmental procedures and the use of masks and respiratory protection equipment.

[Spatiotemporal distribution of tuberculosis cases in the city of Saint-Louis Senegal from 2008-2011]. / Répartition spatio-temporelle des cas de tuberculose dans la ville de Saint-Louis du Sénégal entre 2008-2011.

BACKGROUND: We studied the incidence of tuberculosis in the health district of Saint-Louis, Senegal over a period of 4years (2008-2011). One thousand three hundred and eighty-six cases were identified, producing an annual standardized incidence ratio of 129 cases per 100,000 inhabitants. RESULTS: Men in the 15-24-year old age group were more likely to be affected, and diagnosis was more common in the second half of the year. Treatment compliance was excellent (96%), and the cure rate of patients with a TB-positive microscopic examination was 95%. The overall treatment failure rate was 1% and the 6-month morality was 2%. Seropositivity, measured in volunteer patients (48%) was 3%. CONCLUSION: A spatial and temporal map of tuberculosis in the city of Saint-Louis, Senegal has been established. A cluster appears to be very likely in Guet Ndar, a particularly dense population zone in a fishing area. There is also a possible secondary cluster at Pikine.

Mesenteric myofibroblastic tumor: NSAID therapy after incomplete resection.

Myofibroblastic tumors are inflammatory tumors that arise in viscera and soft tissue; their etiopathology is poorly understood. They are capable of infiltration of adjacent organs, local recurrence after surgical resection, and even of distant metastasis. These characteristics result in persistent debate as to the nature of these lesions - whether they are inflammatory or neoplastic, benign or malignant lesions? Diagnosis is almost always made based on histopathological findings. Traditional management is complete surgical excision, but this may be difficult or impossible when the lesion develops in proximity to vital structures. We report the case of a 59-year-old man who was treated in our institution for mesenteric myofibroblastic tumor. Complete resection was not possible due to local infiltration of the mesentery. Recurrence was noted 3 months after surgery; treatment with steroidal and then non-steroidal anti-inflammatory medications (NSAIDs) resulted in clinical and radiologic regression of the tumor.

Indirect inguinal hernia masquerading as a Spigelian hernia.

Inguinal hernia usually developed and descended into scrotum. The clinical presentation is inguinal or inguino-scrotal swelling. Abdominal wall weakness as it is frequently seen in African tropical zones produces often rare clinical case. We report a case of inguinal hernia presented as an abdominal wall swelling clinically suggestive of a Spigelian hernia and discuss the mechanism.

Phylogenetic analyses of symbiotic genes and characterization of functional traits of Mesorhizobium spp. strains associated with the promiscuous species Acacia seyal Del.

AIMS: To assess the phenotypic, symbiotic and genotypic diversity scope of Mesorhizobium spp. strains associated with Acacia seyal (Del.) isolated from different agro-ecological zones in Senegal, and uses of susceptible microbial inoculum in a reafforestation process. METHODS AND RESULTS: A polyphasic approach including phenotypic and genotypic techniques was used to study the diversity and their relationships with other biovars and species of rhizobia. The geographical origins of the strains have limited effect on their phylogenetic and phenotypic classification. Nodulation tests indicated promiscuity of the strains studied, because they were capable of nodulating six woody legume species (Acacia auriculiformis, Acacia senegal, A. seyal, Acacia tortilis ssp. raddiana, Leucaena leucocephala and Prosopis juliflora). Sequencing and phylogenetic analyses of nodA, nodC and nifH genes pointed out that in contrast to nodA gene, the phylogenies of nodC and nifH genes were not consistent with that of 16S rRNA, indicating that these genes of the A. seyal-nodulating rhizobia might have different origins. Microbial inoculation on nonsterile soil had significant effect on the nodules number and the growth of the seedlings, indicating that these strains of rhizobia might be used as inoculum. CONCLUSIONS: The results indicated that A. seyal is a nonselective host that can establish effective symbiosis with Mesorhizobium spp. strains from diverse genomic backgrounds and that the selected A. seyal-nodulating rhizobia could enhance plant growth. SIGNIFICANCE AND IMPACT OF THE STUDY: These results showed the important role that A. seyal could play in the improvement of reafforestation process as a promiscuous host, which can establish effective symbiosis with rhizobia from diverse genomic backgrounds.

[Enhancing the anthelminthic activity roots of Annona sengalensis]. / Mise en evidence de l'activite antihelminthique des racines d'Annona senegalensis.

INTRODUCTION: Annona senegalensis is a plant largely used in traditional medicine in Africa. The roots showed an antiparsitic activity. The purpose of this work is to determine through bioassay on Rhabditis pseudoelongata the activity of the roots of Annona senegalensis and characterise if any substances responsible for this activity. MATERIAL AND METHODS: The vegetable material consists of roots of Annona senegalensis collected in Casamance at 1999. The tests of activity are carried out on Rhabditis pseudoelongata, stock L. Lamy, Institut Pasteur, Paris. Powder of roots (1070 g) was extracted with methanol. From this rough extract, we carried out two extractions with the dichloromethane of which one after passages in alkaline and acid medium. Various extracts were subjected to a chromatography on column of silica gel or from alumina gel; some compounds were isolated by high performance liquid chromatography . The identification of compounds was deed using spectrometric techniques (mass, Ultraviolet, Infrared) and nuclear magnetic resonance. The tests of activity related to three extracts and seven molecules isolated from the roots. The percentage of dead worm is determined after two hours of contact with demineralised water containing the sample to be tested. RESULTS: The neutral extract chloromethylenic showed an important activity on Rhabditis pseudoelongata. Five acetogenines were insulated starting from this extract chloromethylenic (gigantetronenine, squamocine, glaucanisine, glaucanetine, goniothalamicine) and two alkaloids starting from the alkaline extract chloromethylenic (liriodenine and norolivéroline). The tests on Rhabditis pseudoelongata of these compounds showed an activity of the squamocine with a IC50 of 0.1 microg/ml and IC90 0.3 microg/ ml more powerful than that of the levamisole, reference substance (IC50 of 0.8 microg/ml and IC90 13 microg/ml). CONCLUSION: The study of the biological activity of the roots of Annona senegalensis made it possible to determine the anthelminthic activity of the extract chloromethylenic from where the squamocine was isolated. The presence of this molecule could explain the anthelminthic activity of this plant.

[Study of the contents in fat, in protein and in vitamin D of powdered milk varieties sold in Dakar]. / Etude des teneurs en matiere grasse, proteines et vitamine D de varietes de lait en poudre vendu a Dakar.

INTRODUCTION: The powdered milk is a much appreciated food in Senegal. However no particular control is realized by authorities on the various marks of milk imported before their marketing. In the concern to protect the health of the consumers, but especially in front of the very big variety of the sources of supply in this product we determined the contents in fat, in protein and in vitamin D main variety show of marketed powdered milk Dakar. MATERIAL AND METHODS: Chemical methods were operated to determine the fat contents and in proteins. The liquid chromatography in high performance was used to identify and measure the vitamin D. RESULTS: The obtained results profits showed that all the studied samples of milk had contents in fat included between 25 and 31 g %, those in proteins were included between 23 and 25 g %. As regards the dosage of the vitamin D, a single sample had content weaker than that mentioned on the packaging by the manufacturer. CONCLUSION: The results of this study allowed to notice most of the variety varieties of powdered milk marketed in Dakar were in accordance with the standards established for this food and are consequently good quality.

Phenotypic and genotypic characteristics of Acacia senegal (L.) Willd. root-nodulating bacteria isolated from soils in the dryland part of Senegal.

AIMS: We characterized phenotypically and genotypically root-nodulating bacteria associated with Acacia senegal (L.) Willd. isolated from the soils surrounding A. senegal trees in the dry land area of Senegal. METHODS AND RESULTS: The phenotypical and genotypical characterizations we carried out showed a high diversity of A. senegal root-nodulating bacteria. Phenotypic patterns showed adaptations of the rhizobial strains to many environmental stresses such as heat, drought, and salinity. Twelve molecular groups were distinguished by profiles obtained using polymerase chain reaction/restriction fragment length polymorphism techniques from intergenic spacer region rDNA. The highest genetic diversity was found around the A. senegal rhizosphere. Therefore, A. senegal seemed to have a positive influence on occurrence and genotypical diversity of rhizobial populations. Rhizobial isolates obtained in this study belonged phylogenetically to the genera Mesorhizobium and Rhizobium. CONCLUSIONS: Our results provided information about the genetic diversity of the rhizobial strains associated with A. senegal and suggested the adaptability of natural rhizobial populations to major ecological environmental stress within these soil environments. SIGNIFICANCE AND IMPACT OF THE STUDY: These results suggested a potential selection of compatible and well adapted strains under stress conditions as inoculants for successful A. senegal growth in arid lands.

[Control of the quality of antiretroviral medicines used in Senegal]. / Controle de la qualite des medicaments antiretroviraux utilises au Senegal.

INTRODUCTION: Success of any program to fight AIDS passes through out quality of antiretroviral medicines. The control and follow-up of the quality of these medicines constitute essential levers to guarantee quality. Our study aims to evaluate the quality of antiretroviral medicines used in Senegal by means of a mini laboratory from the German Pharmaceutical Health Fund. MATERIALS AND METHODS: The mini laboratory provides technical arsenal necessary for the analysis. To sum up, 43 samples of antiretroviral medicines have been submitted to three types of simple, quick and reliable tests which are physical and visual inspection, disintegration and thin layer chromatography. RESULTS: The obtained results give at physical and visual inspection, 9.3% of samples which are not similar. 30 samples out of 32 have a good disintegration time. About 11.6% of samples are not similar to thin layer chromatography. CONCLUSION: The control of the quality of antiretroviral medicines is necessary if we consider the number of no conform cases which are relatively important. The mini laboratory can constitute an interesting tool for technical control facilities in developing countries that suffer from a real lack of materials.

[Cytotoxic activity of two cyclic peptides from the latex of Jatropha integerrima Euphorbiaceae]. / Etude de l'activite cytotoxique de deux cyclopeptides isoles du latex de jatropha integerrima euphorbiaceae.

Activity-guided fractionation of the ethyl acetate extract of the latex of Jatropha integerrima Euphorbiaceae combinated with cytotoxic assay against the KB human nasopharyngeal carcinoma cells, resulted to the isolation by chromatographic methods including HPLC of two new cyclopeptides: integerrimacyclopeptide4 and integerrima cyclopeptide B. The amino acid composition was established after hydrolysis and derivatization. All chiral amino acids were L configuration and were hydrophobic. Their sequences were determined by MS fragmentations (ESI-q-TOF, MS/MS) and confirmed by 2D NMR homo- and heteronuclear studies. Integerrimacyclopeptide A was a cyclooctapeptide with m/z 766 corresponding to the molecular formula C37H66N8O9. Analysis of mass spectra gave b(n) and a(n) acylium ion series which the sequence could be deduced: cyclo(Leu-Gly-Ser-Ile-Ile-Leu-Gly-lle). This structure was confirmed by interpretation of HMBC and ROESY spectra. Likewise, integerrimacyclopeptide B was a cycloheptapeptide with m/z 651 and C31H53N7O8 as molecular formula containing one proline residue: cyclo(Pro-Gly-Thr-Ile-Gly-Ile-Leu). These two cyclic peptides exhibited significant cytotoxic activityin vitro against KB tumorales cells with respective IC50 values of 0.46 +/- 0.04 and 0.66 +/-0.08 microg/ml.

[Allergies in ENT]. / Les allergies en ORL.

Allergy is quite frequent and ENT syptoms are usually the visible part of a general disease. Questioning remains the most important part of the enquiry for clinical examination is usually poor if notdesapointing. Biological testings detailed in this paper may be of some help; In Africa, test-treatements using cheap and unharmfull drugs give often the best evidence of allergy. Seldom, ENT allergy may be or become life-threatening. Its detection and appropiate actions are briefly mentioned.

[Retrograde intramedullary nailing for humeral shaft fractures in adults. Evaluation of anatomical and functional results in 63 cases]. / Embrochage centromédullaire ascendant des fractures diaphysaires de l'humérus de l'adulte. Evaluation des résultats anatomiques et fonctionnels a propos de 63 cas.

PURPOSE OF THE STUDY: Many methods have been proposed for treatment of displaced humeral shaft fractures in adults. This study was designed to evaluate the anatomical and functional results of patients treated by retrograde intramedullary nailing through the lateral condyle. MATERIALS AND METHODS: Sixty-three fresh traumatic fractures of the humerus were treated between January 2000 and January 2003. Five patients were lost to follow-up. The AO classification and the Hackethal classification modified by De La Caffinière were used. Outcome was assessed according to the modified Stewart and Hundey classification. RESULTS: We had 23 very good results, 26 good results, five passable results and four bad results. The bad results were three cases of non-union and one case with poor function (stiffness of elbow and shoulder). Mean delay to union was ten weeks four days. There were no cases of iatrogenic radial nerve palsy or pin migration. CONCLUSION: Retrograde intramedullary nailing is a reliable method, easy to perform and of low economic cost. We propose it for all types of displaced shaft humeral fractures.

[Antiparasitic effect of Senegalese Annonaceae used in traditional medicine]. / Activités antiparasitaires d'Annonaceae du Sénégal utilisées en médecine traditionnelle.

Annonaceae is a large family of plants widely used in alimentation and traditional medicine. The interest of their study is raised up by the presence of biologically active substances among that the acetogenins which are specific to them. In Senegal, three species are widely used in traditional medicine for various indications and particularly in parasitic diseases: Annona senegalensis, Uvaria chamae and Xylopia aethiopica. The study of antiparasitical extracts from various organs showed an interesting activity of the fruits and leaves of Xylopia aethiopica on Leishmania donovani, the stem barks and roots of Uvaria chamae on Trypanosomia brucei and the roots of Annona senegalensis on the chloroquino-resistant strain of Plasmodium falciparum. Bioguided fractionation of the active extracts led to isolate Annonaceous acetogenins. Therefore, thirteen acetogenins, from the roots of Uvaria chamae and Annona senegalensis, were identified. The presence of acetogenins, substances with antiparasitical activity, could partly explain the biological proprieties of these various drugs.

[Sensitivity to cotrimoxazole of bacteria isolated at the Central University Hospital of Fann, Dakar]. / Sensibilité au cotrimoxazole des bactéries isolées au CHU de Fann-Dakar.

This study concern a survey of bacterial resistance to cotrimoxazole; 510 strains of Enterobacteria (167), Vibrio cholerae(206) and Staphylococcus aureus(137) were tested by disc diffusion and agar dilution methods. An interview was conducted with 86 health personals to appreciate the influence of prescription. Staphylococcus aureus were the most susceptible bacteria (13% of resistance), and Vibrio cholerae the most resistant (95%). Related to the gender, Enterobacteria present 43 to 72% of resistance. The data of interview show a very frequent use of cotrimoxazole, related to the disponibility and the accessibility of this drug.