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Ki KB, Sanou FF, Ndoye Diop M, Guibla I, Traore M, Donamou J, Mangane M, Kabre Y, Daddy H, Cikwanine BJP, Sama H, Akodjenou J, Bonte AKDAN, Metogo Mbengono J, Nguessan Yapi F, Kabore F, Zoumenou E, Ouedraogo N, Brouh Y. Advances in pediatric anesthesia services over the past 10 years in French-speaking sub-Saharan Africa. Paediatr Anaesth 2024. [PMID: 38655778 DOI: 10.1111/pan.14904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION To improve and maintain quality and safety in anesthesia, standards have been proposed regarding human resources, facilities and equipment, medications and intravenous fluids, monitoring, and the conduct of anesthesia. Compliance with these standards remains a challenge in French-speaking sub-Saharan Africa (SSA) and results in high morbidity and mortality particularly in children. This aim of this study was to assess the progress made in improving the pediatric anesthesia infrastructures, human resources, education, medications, and equipment in French-speaking SSA over the past 10 years (2013-2022). METHODS This is a descriptive, multicenter, cross-sectional study with retrospective data collection, conducted from September 1 to November 5, 2023. Comparative data from 2012 to 2022 were collected through an online survey. Descriptive statistics were used to summarize data. RESULTS Data were obtained from 12 countries out of 14. The number of hospitals providing pediatric surgery and anesthesia rose from 94 in 2012 to 142 in 2022 (+51%). The total number of physician anesthesiologists rose from 293 (0.1 physician anesthesiologists/100 000 inhabitants) in 2012 to 597 (0.2 physician anesthesiologists/100 000 inhabitants) in 2022 (+103.7%). Five (0.006 physician anesthesiologists/100 000 children) had completed a fellowship in pediatric anesthesia and intensive care in 2012, and 15 (0.01 physician anesthesiologists/100 000 children) in 2022 (+200%). Five physician anesthesiologists had an exclusive pediatric anesthesia practice in 2012, whereas they were 32 in 2022 (+540%). There is no specialized training in pediatric anesthesia and intensive care in any of these countries. Halothane was always available in 81.5% of the hospitals in 2012, and in 50.4% of the hospitals in 2022. Sevoflurane was always available in 5% of the hospitals in 2012, and in 36.2% in 2022. Morphine was always available in 32.2% in 2012, whereas it was available in 52.9% of them in 2022. Pediatric pulse oximeter sensors were available in 36% of the hospitals in 2012, and in 63.4% in 2022. Capnography was available in 5.3% of the hospitals in 2012, and in 48% in 2022. CONCLUSION Progress have been made over the last 10 years in French-speaking SSA to improve infrastructures, human resources, education, medications, and equipment for pediatric anesthesia in French-speaking SSA. However, major efforts must be continued. Standards adapted to the local context should be formulated.
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Affiliation(s)
- Kélan Bertille Ki
- Charles de Gaulle Pediatric University Hospital, Ouagadougou, Burkina Faso
| | | | | | - Ismael Guibla
- Sourô Sanou University Hospital, Bobo-Dioulasso, Burkina Faso
| | | | | | | | - Yvette Kabre
- Charles de Gaulle Pediatric University Hospital, Ouagadougou, Burkina Faso
| | | | | | - Hamza Sama
- Sylvanus Olympio University Hospital, Lomé, Togo
| | | | | | | | | | - Flavien Kabore
- Tengandogo University Hospital, Ouagadougou, Burkina Faso
| | - Eugène Zoumenou
- Hubert Koutoukou Maga National University Hospital, Cotonou, Benin
| | | | - Yapo Brouh
- Mother-and-children hospital Bingerville, Abidjan, Ivory Coast
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Mami I, Mande R, Ouedraogo N, Jebali H, Béji S, Zouaghi K. Maladie diabétique chronique : quand référer au néphrologue ? Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lankoandé M, Bonkoungou P, K Ki B, Flavien R Kaboré A, Ouangré E, Savadogo Y, Thw Bougouma C, Sanou J, Ouedraogo N, Pendeville P. Economic and psychological burden of scheduled surgery cancellation in a sub-Saharan country (Burkina Faso). Southern African Journal of Anaesthesia and Analgesia 2017. [DOI: 10.1080/22201181.2017.1379788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Martin Lankoandé
- Department of Anaesthesiology and Intensive Care, Yalgado Ouedraogo Hospital, Burkina Faso
| | | | - Bertille K Ki
- Department of Anaesthesiology, Pediatric Hospital Charles De Gaulles, Burkina Faso
| | - Armel Flavien R Kaboré
- Department of Anaesthesiology and Intensive Care, Yalgado Ouedraogo Hospital, Burkina Faso
| | - Edgar Ouangré
- General and Digestive Surgery, Yalgado Ouedraogo Hospital, Burkina Faso
| | | | - Cheik Thw Bougouma
- Department of Anaesthesiology and Intensive Care, Blaise Compaore Hospital, Burkina Faso
| | - Joachim Sanou
- Department of Anaesthesiology and Intensive Care, Yalgado Ouedraogo Hospital, Burkina Faso
| | - Nazinigouba Ouedraogo
- Department of Anaesthesiology and Resuscitation, Yalgado Ouedraogo Hospital, Burkina Faso
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Kabore AF, Ouedraogo A, Ki KB, Traore SSI, Traore IA, Bougouma CTH, Arnaudovski D, Diallo O, Zabsonre S, Ouedraogo N, Augustin P. Head Computed Tomography Scan in Isolated Traumatic Brain Injury in a Low-Income Country. World Neurosurg 2017; 107:382-388. [PMID: 28826717 DOI: 10.1016/j.wneu.2017.07.160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Head computed tomography scan (HCTS) is the cornerstone of the management of traumatic brain injury (TBI). The impact of performing a HCTS in TBI has been scarcely investigated in low-income countries (LICs). Furthermore, the cost of a HCTS is a burden for family finances. METHODS A prospective observational study was conducted in Burkina Faso. All consecutive patients with isolated TBI needing a HCTS were included. Result and impact of HCTS were evaluated. RESULTS There were 183 patients prescribed a HCTS for an isolated TBI. Mild, moderate, and severe TBIs represented 55%, 31%, and 14% of the cases, respectively. In 72 patients, HCTS was not performed because of economic barrier. Among the 110 HCTSs performed, there were intracranial lesions in 81 (74%) patients. Among the 110 performed HCTS, 34 (31% [22.3%-39.5%]) HCTSs altered the management of TBI, with 16 (15%) cases of surgical indications, and 20 (18%) cases of modification of the medical treatment. In patients without neurologic signs, the rate of alteration of management was 28%. The realization of the HCTSs was associated with the presence of neurologic signs and income level. In-hospital mortality was 11% (n = 21). Among the 162 patients discharged alive from the hospital, 27 (20%) were discharged with a severe disability state (Glasgow Outcome Scale score ≤3). The rate of return to work was 77%. CONCLUSIONS No modification of guidelines can be advocated from this study. However, given the financial burden on family of performing HCTS, research may identify criteria allowing for avoiding HCTS. Guidelines specific to LICs are needed to get closer to the best interest of patients.
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Affiliation(s)
- Armel Flavien Kabore
- Service d'Anesthésie Réanimation, Centre Hospitalier Universitaire, Yalgado Ouédraogo, Ouagadougou, Burkina-Faso; Université Ouaga 1 Pr Joseph KI-Zerbo, Unité de Formation et de recherche en sciences de la santé, Ouagadougou, Burkina-Faso
| | - Aziz Ouedraogo
- Service d'Anesthésie Réanimation, Centre Hospitalier Universitaire, Yalgado Ouédraogo, Ouagadougou, Burkina-Faso
| | - Kélan Bertille Ki
- Université Ouaga 1 Pr Joseph KI-Zerbo, Unité de Formation et de recherche en sciences de la santé, Ouagadougou, Burkina-Faso; Service d'Anesthésie Réanimation, Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina-Faso
| | - Salah Seif Idriss Traore
- Service d'Anesthésie Réanimation, Centre Hospitalier Universitaire, Yalgado Ouédraogo, Ouagadougou, Burkina-Faso
| | - Ibrahim Alain Traore
- Service d'Anesthésie Réanimation, Centre Hospitalier Universitaire Souro Sanou, Bobo Dioulasso, Burkina-Faso; Universite Polytechnique de Bobo Dioulasso, Bobo Dioulasso, Burkina-Faso
| | - Cheik Tidiane Hafiz Bougouma
- Université Ouaga 1 Pr Joseph KI-Zerbo, Unité de Formation et de recherche en sciences de la santé, Ouagadougou, Burkina-Faso; Service d'Anesthésie Réanimation, Centre Hospitalier Universitaire de Tengandogo, Ouagadougou, Burkina-Faso
| | - Darko Arnaudovski
- Département d'anesthésie réanimation, Centre Hospitalier Universitaire Bichat Claude Bernard, Paris, France
| | - Ousseini Diallo
- Service d'Imagerie Médicale, Centre Hospitalier Universitaire, Yalgado Ouédraogo, Ouagadougou, Burkina-Faso; Université Ouaga 1 Pr Joseph KI-Zerbo, Unité de Formation et de recherche en sciences de la santé, Ouagadougou, Burkina-Faso
| | - Sylvain Zabsonre
- Service de Neurochirurgie, Centre Hospitalier Universitaire, Yalgado Ouédraogo, Ouagadougou, Burkina-Faso; Université Ouaga 1 Pr Joseph KI-Zerbo, Unité de Formation et de recherche en sciences de la santé, Ouagadougou, Burkina-Faso
| | - Nazinigouba Ouedraogo
- Service d'Anesthésie Réanimation, Centre Hospitalier Universitaire, Yalgado Ouédraogo, Ouagadougou, Burkina-Faso; Université Ouaga 1 Pr Joseph KI-Zerbo, Unité de Formation et de recherche en sciences de la santé, Ouagadougou, Burkina-Faso
| | - Pascal Augustin
- Département d'anesthésie réanimation, Centre Hospitalier Universitaire Bichat Claude Bernard, Paris, France.
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Audat G, Harbonnier M, Ouedraogo N, Leftheriotis G, Abraham P. Comparison of reported symptoms to those produced by treadmill testing in patients with claudication suspected of arterial origin. INT ANGIOL 2014; 33:379-383. [PMID: 25056170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM We aimed at comparing lower limb symptoms reported by history to those observed during a standard treadmill test. METHODS We retrospectively studied symptomatic patients referred over a three years period for suspected arterial claudication and used the Edinburgh claudication questionnaire before exercise and symptoms observed on a treadmill. We confronted, right and left, proximal (lower-back thigh or buttocks) and distal (leg or foot) lower-limb symptoms before and during treadmill exercise. Results are reported as mean ± standard deviation for percentage and 95% confidence interval and Kappa statistics are performed. RESULTS Of 795 patients with claudication, aged 63 ± 12 years, treadmill test resulted in 715 reporting lower-limb symptoms on treadmill. Cohen's Kappa for the site-specific analysis of symptoms by history vs. symptoms on treadmill was 0.509 ± 0.21 (P < 0.01), showing a moderate agreement. Nevertheless, symptoms on treadmill reproduced, at least partly, symptoms by history in 675 (84.9% 95CI: 82.3-87.2) of patients, although symptoms on treadmill were strictly of the same localizations as symptoms by history in only 378 (47.6% 95CI: 44.1-51.0) of all studied patients. Last, 279 patients (35.1% of all patients) reported non limb symptoms on treadmill. CONCLUSION Although on a site by site basis the concordance of symptoms by history to symptoms by treadmill is moderate, most patients reproduced their usual symptoms on treadmill. Age does not seem to impair the concordance. Last, beyond the sole measurement of maximal walking capacity, treadmill frequently unmasks non-limb limiting symptoms that may require clinical attention.
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Affiliation(s)
- G Audat
- Université Angers, CHU Angers, Laboratory for Vascular Investigations. Angers Cedex 09, France -
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Ouedraogo N. 52: A Safe Community-Based Campaign to Promote the use of Bicycle Helmets in Children. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abraham P, Godet R, Harbonnier M, Laneelle D, Leftheriotis G, Ouedraogo N. External Validation of the “Walking Estimated Limitation Calculated by History” (WELCH) Questionnaire in Patients with Claudication. Eur J Vasc Endovasc Surg 2014; 47:319-25. [PMID: 24445082 DOI: 10.1016/j.ejvs.2013.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 11/22/2013] [Indexed: 10/26/2022]
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Kabore RAF, Ki KB, Traore AI, Bougouma CTW, Damba J, Bonkoungou PZ, Sanou J, Ouedraogo N. [Assessment of knowledge and pain management by traumatological emergencies staff of the teaching hospital of Ouagadougou]. Mali Med 2014; 29:1-5. [PMID: 30049133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Pain is a frequent reason of consultation in traumatological emergencies. Its management is characterized by oligoanalgesia whose causes are multiple. The purpose of this study is to assess the knowledge and practices of pain management by traumatological emergencies staff of the teaching hospital Yalgado Ouedraogo of Ouagadougou. MATERIALS AND METHODS A questionnaire survey of health workers performing in traumatological emergencies has been conducted. Two different questionnaires, one for medical staff and one for the paramedics were administered. RESULTS A total of 67 health workers participated in the study with a participation rate of 98% and 100%, respectively, for the medical and paramedical staff. According to their report, 65.3% of medical and 77.7% of paramedical staff had never received training on pain and its management. For 85.7% of physicians, pain should be assessed before treatment, but 79.6% of them didn't know any conventional pain assessment method. All the nurses and 40.8% of physicians felt that pain in the emergency services should not be treated immediately to prevent misdiagnosis. Morphine and regional anesthesia were not used for pain treatment in the emergency room. 10.2% of medical staff and 27.8% of the paramedics said that they systematically search for the analgesicsside effects. CONCLUSION The knowledge of health workers about pain and its management is insufficient. The lack of training of health workers on the management of pain is the cause and contributes to explain the oligoanalgesia in this service.
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Affiliation(s)
- R A F Kabore
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle de Ouagadougou
| | - K B Ki
- Centre Hospitalier Universitaire Souro Sanou de Bobo Dioulasso
| | - A I Traore
- Centre Hospitalier Universitaire Souro Sanou de Bobo Dioulasso
| | - C T W Bougouma
- Centre Hospitalier National Blaise Compaoré de Ouagadougou
| | - J Damba
- Centre Hospitalier Universitaire Yalgado Ouédraogo de Ouagadougou
| | - P Z Bonkoungou
- Centre Hospitalier Universitaire Yalgado Ouédraogo de Ouagadougou
| | - J Sanou
- Centre Hospitalier Universitaire Yalgado Ouédraogo de Ouagadougou
| | - N Ouedraogo
- Centre Hospitalier Universitaire Yalgado Ouédraogo de Ouagadougou
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Kabore RAF, Bandre E, Tapsoba T, Ouedraogo I, Traore IA, Ouedraogo N, Wandaogo A. Hernie diaphragmatique post-traumatique de l’enfant: à propos d’un cas au Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle de Ouagadougou. Pan Afr Med J 2013; 16:55. [PMID: 24672626 PMCID: PMC3964013 DOI: 10.11604/pamj.2013.16.55.2894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 10/02/2013] [Indexed: 12/03/2022] Open
Abstract
La hernie diaphragmatique post-traumatique est une urgence chirurgicale rare chez l’enfant mais pouvant mettre rapidement en jeu le pronostic vital. Les auteurs rapportent le cas d’un garçon de 04 ans admis aux urgences pour douleur abdominale suite à une contusion thoraco-abdominale par accident de la voie publique. Le bilan radiologique initial a consisté en une échographie abdominale qui a révélé un hémopéritoine de petite abondance sans lésion focale. Douze heures après son admission, le patient a présenté une détresse respiratoire avec tableau clinique de pneumothorax gauche qui a nécessité une exsufflation en urgence. Le diagnostic de hernie diaphragmatique gauche a été posé à la radiographie du thorax réalisée après la ponction. L’enfant a bénéficié d’une cure chirurgicale. L’évolution a été favorable. La hernie diaphragmatique post traumatique, bien que rare chez l’enfant, devrait être systématiquement recherchée par une radiographie thoracique ou un scanner thoraco-abdominal devant tout traumatisme abdominal avec hyper pression. Son traitement est chirurgical.
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Affiliation(s)
| | - Emile Bandre
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle de Ouagadougou, Burkina Faso
| | - Toussaint Tapsoba
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle de Ouagadougou, Burkina Faso
| | - Isso Ouedraogo
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle de Ouagadougou, Burkina Faso
| | | | | | - Albert Wandaogo
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle de Ouagadougou, Burkina Faso
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Ouedraogo N, Marchand J, Bondarenko M, Picquet J, Leftheriotis G, Abraham P. Estimation of Running Capacity can Likely be Removed from Questionnaires Estimating Walking Impairment in Patients with Claudication. Eur J Vasc Endovasc Surg 2012; 43:705-10. [DOI: 10.1016/j.ejvs.2012.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 02/08/2012] [Indexed: 11/16/2022]
Affiliation(s)
- N Ouedraogo
- Laboratory for Vascular Investigations, University Hospital, 4 rue Larrey, Angers Cedex 09, France
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Abstract
AIM To compare symptoms and walking capacities of patients with and without diabetes reporting vascular-type claudication. METHODS We recorded self-reported maximal walking distance, maximal walking distance on treadmill test (3.2 km h(-1) , 10% slope), exercise transcutaneous oxygen pressure DROP index [limb transcutaneous oxygen pressure (TcpO2) changes from rest minus chest TcpO2 changes from rest] and symptoms on treadmill in 230 patients with diabetes and 982 patients without diabetes. Exercise-induced proximal and distal symptoms were analysed in the perspective of underlying proximal and distal ischaemia (DROP value < negative 15 mmHg). RESULTS Self-reported maximal walking distance did not differ between groups, whereas maximal walking distance on treadmill test was lower in patients with diabetes vs. patients without diabetes (261 ± 257 and 339 ± 326 m, respectively; P < 0.05 when adjusted for potential confounders). In patients with ischaemia, the number of ischaemic areas (proximal and/or distal on right and/or left) was comparable between the two groups. Patients with diabetes had more distal ischaemia than patients without diabetes (38 vs. 29%, respectively; P < 0.01), whereas proximal ischaemia was similar between groups. The prevalence of lower-limb exercise-related symptoms without ischaemia was comparable between groups. There were more symptoms other than lower-limb pain in patients with diabetes than patients without diabetes (29.6 vs. 18.3%, respectively; P < 0.01). CONCLUSIONS Patients with diabetes show more severe limitation on the treadmill and more non-limb symptoms than patients without diabetes, although self-reported walking capacity is comparable between the two groups. Using TcpO2, we confirm that patients with diabetes reporting claudication show more distal ischaemia than patients without diabetes, with no difference at the buttock level. Treadmill testing is of interest in patients with peripheral artery disease and diabetes.
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Affiliation(s)
- G Mahé
- Department of Physiology and Vascular Investigations, University Hospital UMR INSERM 771 - CNRS 6214, France
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Ouedraogo N, Feuilloy M, Mahe G, Leftheriotis G, Saumet JL, Abraham P. Chest tcpO2changes during constant-load treadmill walking tests in patients with claudication. Physiol Meas 2010; 32:181-94. [DOI: 10.1088/0967-3334/32/2/003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Trueba F, Blade J, Kerangal X, Ouedraogo N, Borne M, Brinquin L. A Man with a Saccular Aneurysm of the Left Common Iliac Artery: (Answer on pages 945–7). Clin Infect Dis 2006. [DOI: 10.1086/507528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Trueba F, Blade JS, De Kerangal X, Ouedraogo N, Borne M, Brinquin L. A man with a saccular aneurysm of the left common iliac artery. Clin Infect Dis 2006; 43:945-7, 902-3. [PMID: 16941374 DOI: 10.1086/507555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- François Trueba
- Department of Clinical Microbiology, Val de Grâce Military Hospital, Paris, France.
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Ouedraogo N, Niakara A, Lougue-Sorgho C. [Abdominal aortic aneurysm manifested by hematemesis in a 32 year old patient infected by HIV]. Med Trop (Mars) 2003; 63:64-7. [PMID: 12891753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Aortic aneurysm is an uncommon in young patients. The purpose of this report is to describe a case of dissecting aortic aneurysm in a 32-year-old man with human immunodeficiency virus (HIV) infection. The presenting symptom was recurrent massive hematemesis. Diagnosis was suspected on the basis of clinical cardiovascular assessment and confirmed by ultrasonography and computed tomography. The clinical course was complicated by superior vena cava syndrome and kidney failure. Outcome in the absence of surgical treatment was fatal. Perusal of the literature indicates a rising incidence of large vessel disease in young patients with HIV infection. The underlying pathophysiological mechanisms is unclear. Assessment for arterial lesions should be performed in all patients with HIV infection since clinical signs may be misleading. Definitive diagnosis can be achieved by ultrasonography, Doppler ultrasound or computed tomography.
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Affiliation(s)
- N Ouedraogo
- Département d'anesthésie-réanimation, Centre Hospitalier National Yalgado Ouédraogo, Ouagadougou, Burkina Faso.
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Abstract
A useful approach for constructing dose-response relationships and for studying the underlying mechanisms by which a xenobiotic agent enhances airway reactivity is to measure the response of an isolated airway following ex vivo exposure to a pollutant. We have in this way determined the dose-response relationship between ex vivo exposure to pollutants such as nitrogen dioxide (NO2), the aldehyde acrolein, and ozone (O3) and the reactivity to agonists in human isolated bronchial smooth muscle. We have also investigated the underlying alteration in the cellular mechanisms of airway smooth-muscle contraction induced by such exposure and found that it is related to alteration in calcium signaling at the site of the airway smooth-muscle cell. Finally, although there is epidemiological evidence that an increase in allergic diseases such as asthma may be linked to air pollution, there are few experimental data to address this issue. The final aim of this study was therefore to investigate the interaction between passive sensitization and exposure to pollutants in human isolated airways. We have examined (i) the effect of a pre-exposure to pollutants on the contraction of sensitized bronchi in response to a specific antigen and (ii) the effect of passive sensitization on the contraction in response to nonspecific agonists in bronchi pre-exposed to pollutants. The results indicate a combined effect of immunological sensitization and exposure to pollutants; that is, passive sensitization and exposure to pollutants act in a synergistic manner on human bronchial smooth-muscle reactivity in response to both specific antigens and nonspecific agonists.
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Affiliation(s)
- E Roux
- Laboratoire de Physiologie Cellulaire Respiratoire, INSERM E9937, Université Bordeaux 2, France
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Ouedraogo N, Vincenti-Rouquette I, Niakara A, Nizou JY, Brinquin L. [Febrile coma and multiple organ failure: suspected hemoglobinopathy SC]. Ann Fr Anesth Reanim 2001; 20:289-93. [PMID: 11332064 DOI: 10.1016/s0750-7658(01)00363-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We report the case of febrile fatal coma in a 51-year-old man from Burkina Faso. Magnetic resonance imaging (MRI) shows cerebral fat embolism. Haemoglobin electrophoresis shows probably haemoglobinopathy SC. A short review of the literature demonstrate the need to consider this complication in patients with neurological or respiratory disorders, in areas where this disease is highly prevalent, irrespective of age. It also emphasizes the diagnostic contribution of MRI and discusses the mechanism, the diagnosis as well as the difficulty of choosing the appropriate therapeutic course.
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Affiliation(s)
- N Ouedraogo
- Service de réanimation, centre hospitalier national universitaire Yalgado Ouedraogo, 03 BP 7022 Ouagadougou 03, Burkina Faso
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Ouedraogo N, Roux E, Forestier F, Rossetti M, Savineau JP, Marthan R. Effects of intravenous anesthetics on normal and passively sensitized human isolated airway smooth muscle. Anesthesiology 1998; 88:317-26. [PMID: 9477050 DOI: 10.1097/00000542-199802000-00008] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND General anesthetics may modify airway responsiveness. The authors investigated the effect of thiopental, propofol, and etomidate on airway smooth muscle. METHODS Contraction experiments were done in human airway rings that were either normal or passively sensitized with asthmatic serum. The effect of propofol and etomidate was also studied on both [Ca2+]i increase measured by microspectrofluorimetry in isolated myocytes and isometric contraction in the rat trachea. RESULTS In human bronchi, thiopental (10[-7] to 10[-4] M) induced a concentration-dependent contraction. Neither propofol nor etomidate altered baseline tone, but both anesthetics reduced histamine-induced contraction. In human immunologically sensitized isolated bronchi, propofol (3 x 10[-4] M) reduced histamine reactivity (deltaFmax in %) to a greater degree than in nonsensitized tissues (64.4 +/- 15.7% and 16.4 +/- 8.5%, respectively; n = 6, P < 0.05), whereas the effect of etomidate (10[-4] M) was similar in both types of tissue (24.1 +/- 6% and 22.3 +/- 15%, respectively, n = 6). In rat isolated tracheal myocytes, propofol (3 x 10[-4] M) and etomidate (10[-4] M) altered the [Ca2+]i signal in response to the depolarizing agent potassium chloride and the muscarinic agonist acetylcholine. Accordingly, the two anesthetics also reduced the mechanical response of rat tracheal rings to these agonists. CONCLUSIONS Whereas thiopental contracts human isolated bronchi, propofol and etomidate reduce histamine-induced contraction in human isolated airway smooth muscle that were either not sensitized or passively sensitized with asthmatic serum. This effect involves inhibition of both electro- and pharmacomechanical coupling.
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Affiliation(s)
- N Ouedraogo
- Laboratoire de Physiologie Cellulaire Respiratoire, Université Victor Ségalen-Bordeaux 2, France
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Niakara A, Ouedraogo N, Auregan G. [Burkina Faso--a multitude of public health emergencies]. Med Trop (Mars) 1998; 58:235-9. [PMID: 10088097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Affiliation(s)
- A Niakara
- Faculté des Sciences de la Santé, Centre National de Lutte Anti-Tuberculeuse, Ouagadougou, Burkina Faso.
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