[Risk of nosocomial infection in Intertropical Africa. Part 4: prevention]. / Le risque nosocomial en Afrique Intertropicale. Partie 4: prévention.

Nosocomial infections have long been neglected in Sub-Saharan Africa, even though their prevalence is higher than in developed countries. Recently, however, this major public health problem has been the focus of a growing number of recommendations not only from the World Health Organization but also from some national health ministries. Because of the numerous limitations especially in financial resources in these regions, priority must be given to the implementation of simple and cost-effective measures. Accordingly the greatest efforts must be devoted to educating healthcare workers and patients about the importance of handwashing, eliminating unnecessary injections and transfusions, performing the latter acts in aseptic conditions, isolating patients with communicable diseases, handling waste products safely, and using antimicrobials properly. Amid the daunting health issues facing Sub-Saharan Africa, implementing these inexpensive measures that could save the lives of thousands of patients and healthcare workers appears easy. However it will require a cultural revolution. The keys to success will be changing the organizational culture, developing a commitment to prevention and evaluating performance regularly.

[Risk of nosocomial infection in intertropical Africa--part 2: patient infection]. / Le risque nosocomial en Afrique intertropicale partie 2: les infections des patients.

Patients admitted to hospitals in tropical Africa are at increased risk for nosocomial infection. However accurate description of this risk is difficult due to a lack of published data in the literature. The main promoting factors are poor health care facilities, high microbial levels in the hospital and community environment and generally uncertain health status. Most available information is about neonatal infection. The increasing number of reports involving multiresistant bacteria is evidence of poor hospital sanitation. Infections involving operative incision sites, tuberculosis and respiratory virus transmission are grossly underestimated. Infections transmitted by the parenteral route are probably decreasing due to more widespread use of disposal equipment and adequate transfusion safety measures. Epidemics involving viral hemorrhagic fever are rare but highly publicized events that attest to daily neglect of nosocomial risk factors in some health care facilities

[A prosthetic joint infection caused by Streptococcus pneumoniae: a case report and review of the literature]. / L'infection à pneumocoque sur prothèse. A propos d'un cas et revue de la littérature.

We report a case of hematogenous streptococcus pneumoniae infection of a total knee arthroplasty observed in an 82-year-old woman who initially presented a lung infection. The therapeutic approach was largely dictated by the patient's precarious general status. Arthroscopic washings were associated with adapted antibiotics followed by removal of the prosthesis and replacement with a spacer. The patient declined further intervention so the prosthesis was not reimplanted. Hematogenous infections of joint prostheses are rarely caused by such streptococcal species. Since this is a well known germ, it would be logical to apply the usual rules for treatment of infected prostheses caused by sensitive germs. However, the analysis of the present case and a review of the literature shows that various therapeutic approaches have been used. These infections appear to be more common in seriously ill patients which could explain this variability. Mortality is high. The number of reported cases is too small to propose a specific treatment.

[Risk of noscomial infection in intertropical Africa--part 1: background]. / Le risque nosocomial en Afrique intertropicale--partie 1: le contexte.

Nosocomial infection is a risk in any health care setting. A review of recent medical literature shows that there is a paucity of information on nosocomial infection in intertropical Africa. Often misunderstood or denied, nosocomial infection is in reality an underestimated public health problem at most medical facilities even university hospital centers. However most hospitals are confronted with the same financial, structural and logistics difficulties, with limited training and awareness about hospital hygiene among caregivers, and with situations bringing together contagious infections with susceptible subjects. Assessment of the risks for patients and caregivers is a necessary prerequisite for implementing measures to control nosocomial infections in intertropical Africa.

[Niger: nutritional recuperation and education in a sub-Saharan urban area]. / Niger: activités de récupération et d'éducation nutritionnelle en zone urbaine sahélienne.

Located in Niamey, capital of Niger, a Sub-Saharian country where the rate of acute malnutrition in children is estimated at 16.8 percent, the National Armed Forces Center for Nutritional Rehabilitation and Education has been expanding its activities since 1986. The center offers curative and educational services to the children of military personnel and the population in neighboring districts. These services are regularly scheduled two and a half or three hours each morning five days a week. In 1990 our center received 115 malnourished children detected either during consultations or infant weighing sessions. Twenty-seven presented moderate protein-caloric malnutrition and 28 serious malnutrition. Medium age at admission was 11 months 16 days and medium length of stay was 9.5 days. Long-term recovery was confirmed in 30.5% while 69.5% were lost from follow-up. Keeping a healthbook throughout the weight control period, enforcing coercive measures for military families, organizing a permanent campaign to maintain awareness of nutritional problems, prolonging opening hours to improve access to the center, and above all improving the level of women's education are necessary to improve these results. Primary prevention requires better family planning with a longer interval between births.

[Anatomical case on the middle meatus of the nasal cavity]. / Note anatomique sur le méat moyen des fosses nasales.

A serie of 20 dissections carried out in the anatomy Laboratory enabled us to make a close observation of the middle meatus of the nasal cavity. Certain anatomical parts such as the bulla, the unciform process, the ostia of the maxillary and frontal sinus are relatively set in their positions, but quite variable in their shape and size. This knowledge is now indispensable, at a time when endonasal microsurgery has become commonplace in ENT.

Proximal femoral nail antirotation (PFN-ATM) fixation of extra-capsular proximal femoral fractures in the elderly: retrospective study in 102 patients.

BACKGROUND: The best surgical strategy for extra-capsular proximal femoral fractures (PFFs) is controversial in the elderly. Poor bone quality and neck screw instability can adversely affect the results with currently available fixation devices, which predominantly consist in dynamic hip screw-plates and proximal reconstruction nails. HYPOTHESIS: The helical blade of the proximal femoral nail antirotation (PFN-A™) achieves better cancellous bone compaction in the femoral neck, thereby decreasing the risk of secondary displacement. MATERIALS AND METHODS: We retrospectively reviewed consecutive cases of PFN-A™ fixation performed between 2006 and 2008 in 102 patients (75 females and 27 males) with a mean age of 84.9 ± 9.5 years (range, 70-100 years). Functional outcomes were assessed using the Parker Mobility Score. RESULTS: Mean follow-up in the 102 patients was 21.3 ± 17.5 months (4-51 months). Fracture distribution in the AO classification scheme was A1, n=45; A2, n=41; and A3, n=16. At last follow-up, Parker Mobility Score values in the 65 survivors were 0-3, n=35; 4-6, n=11; and 7-9, n=19. Fracture union was consistently achieved, after a mean of 10.3 ± 3 weeks. Blade back-out allowed by the device design occurred in 16 (15.7%) patients but caused pain due to screw impingement on the fascia lata in only five patients (of whom two underwent reoperation). Cephalic blade cut-out was noted in three (2.9%) patients, of whom one required reoperation because of acetabular penetration. Two hardware-related fractures were recorded. DISCUSSION: The new PFN-A™ device ensures reliable fixation with low mechanical complication rates. Although our data do not constitute proof that a helical blade is superior over a neck screw, they suggest a decreased rate of construct failure and may serve as a basis for a comparative study.