[Risks and benefits of spirometry in preoperative assessment for the surgical repair of abdominal aortic aneurysm]. / Risques et bénéfices de la spirométrie avant réparation chirurgicale de l'anévrisme de l'aorte abdominale.

Since 2019, spirometry is no longer contraindicated in patients with an aneurysm of the abdominal aorta (AAA). Lung function testing has therefore become a tool for the preoperative morbidity and mortality assessment of patients eligible for surgical repair of AAA. European guidelines of anesthesiology, vascular surgery and pneumology, recommend preoperative spirometry for polymorbide patients, for whom the preoperative assessment must be as complete as possible in order to improve perioperative management and to help specialists decide of the operative mode: open (for patients with a low-risk profile) or endovascular (preferred in high-risk profile patients).

Depuis 2019, la spirométrie n'est plus contre-indiquée chez les personnes porteuses d'un anévrisme de l'aorte abdominale (AAA). Elle peut donc être considérée comme un outil supplémentaire dans le bilan préopératoire des patients candidats à une réparation chirurgicale de l'AAA. Les guidelines européennes de chirurgie vasculaire, de pneumologie et d'anesthésie la recommandent pour les patients polymorbides chez qui l'évaluation du risque péri-opératoire doit être la plus complète possible, afin d'améliorer la prise en charge péri-opératoire et d'aiguiller les spécialistes dans le choix de la technique d'intervention, à abdomen ouvert, pour les patients les plus sains et jeunes (à bas risque), ou par voie endovasculaire, préférée pour les patients âgés et/ou polymorbides (à haut risque).

Dealing with snakebite in rural Cameroon: A qualitative investigation among victims and traditional healers.

BACKGROUND: Snakebite is a neglected tropical disease (NTD) affecting rural and remote populations globally, who are additionally burdened by poverty and the lack of effective healthcare systems. Delayed healthcare and use of traditional treatments are very frequent. The purpose of our study was to explore perceptions of snakes, impact of snakebite, and knowledge and opinions of different snakebite treatments with the aim of identifying opportunities for improving snakebite management. METHODS: This is a qualitative descriptive study based on semi-structured interviews with 21 snakebite victims and 4 traditional healers in 4 villages of Akonolinga health district, Center Region, Cameroon. Analysis focused on describing participants' perceptions of snakes, the impact of snakebite on the victims' lives, and their opinions of different treatment options. RESULTS: Respondents were fearful of snakes and knowledgeable about envenoming symptoms and treatments. The experience of snakebite led to increased vigilance and avoidance behaviours, which sometimes resulted in financial loss for the victims. A range of traditional treatments were described, including tourniquets, black-stone application and medicinal plant decoctions. However, opinions were ambivalent regarding their efficacy, depending especially on previous personal experiences. Still, traditional treatments were said to be more available and cheaper than hospital care, and in particular, than antivenom. Nevertheless, most victims preferred hospital treatment if the financial and transportation barriers were lifted. Both snakebite victims and traditional healers were of the opinion that collaboration between health services and traditional healers could help to improve snakebite management and outcomes. CONCLUSION: Our study shows that snakebite victims are in favour of using antivenom for the treatment of snakebite and would welcome better access to it. However, its current unavailability and high cost pushes them to turn to traditional treatments. On the other hand, traditional healers are in favour of collaborating with health facilities. These results are very encouraging for the improvement of snakebite management in Cameroon along the lines of the WHO Snakebite Envenoming Strategy for Prevention and Control: ensuring access to safe and effective treatment, and increasing partnership and coordination between communities, traditional healers, and conventional caregivers.