[Infections associated with the care in the department of gynecology - obstetrics of the University Hospital Center Gabriel Touré]

OBJECTIF

the purpose of this work was to study the infections associated with the care in the department of gynecology - obstetrics of the University Hospital Center Gabriel Touré (CHU G. Touré).

PATIENTS AND METHODS

This was an epidemiological, descriptive, and analytical study carried out in the gynecology-obstetrics department of G. Touré University Hospital, from April 11, 2016 to August 29, 2016 (4 monthset 18 days), with a prospective collection of data that focused on the characteristics clinical and laboratory-based care-associated infections in patients during their hospitalization. Included in the study were all hospitalized patients (operated or not) in the gynecology obstetrics department, who agreed to participate in the study. The criteria used to diagnose the infection associated with care were those of the CDC Atlanta and making a thick drop in our context. Operative wound monitoring was performed until the 30th postoperative day.

RESULTS

We recorded 200 patients, including 138 operated and 62 nonoperated patients, of which 30 patients developed a care-associated infection at a rate of 15%. The mean age of the patients who presented an infection was 32.52 years ± 13.36 years against 29.36 years ± 10.28 years for the patients who did not present the infection. Seven point five percent of the evacuees had an infection associated with care. The most common types of infections were surgical site infection with 56.60% followed by malaria with 23.30% and urinary tract infection with 20.00%. Escherichia coli and Acinetobacter baumaniiwere the most recovered germs. Isolated organisms were 100% resistant to Amoxicillin, 88.88% were resistant to Ciprofloxacin and 77.77% were resistant to Amoxicillin + Clavulanic acid. The average duration of hospitalization for patients who developed the infection was 14.70 days with extremes of 5 and 46 days. The mortality rate was 1.50%. The average cost of management of patients who developed the infection was 119837 FCFA; the extremes were 17750 and 825750 FCFA and the standard deviation of 174998 CFA francs.

CONCLUSION

the infections associated with the care remain frequent in our service and dominated by the infections of the operating site. The isolated organisms were all 100% resistant to Amoxicillin in 88.88% Ciprofloxacin.

[Subdural empyema complicating acute frontal sinusitis. Four cases report]

OBJECTIVE

Subdural empyema is a collected cranioencephalic suppuration between arachnoid and dura meninge space. Subdural empyema occurring after sinusitis is an uncommon but serious complication of paranasal sinus infections. The purpose of this study is to aware the clinician about this condition. MATERIAL ET METHOD: Four young male children had been admitted with expressed fronto-ethmoid sinusitis. The intracranial infection was confirmed by computed tomography scan of brain and sinus. Both drainage of the sinus and intracranial suppuration was performed at the same time surgical procedure and antibiotics administered during 4 weeks.

RESULTS

The subdural empyema was localized in the right temporoparietal region in 1 case, in the frontal lobe in the others cases. In 1 case, the frontal subdural empyema was associated with an inerhemispherique collection. One patient underwent a second drainage. Immediate post-operative outcomes were temporally complicated with convulsions and focal neurological deficit, in 1 case. This symptoms had regressed spontaneously. There was no case of death. The functional prognosis was bad, marked by lost vision in 2 cases, which was bilateral in 1 case.

CONCLUSION

A high index of suspicion of intracranial extension of sinus infection must recommended neuroradiological investigations. When suppurative collection is confirmed, an appropriated management of the infection between otorhinolaryngologists and neurosurgeons is necessary.

[Epidemiological and angiofluorographic aspects of diabetic retinopathy in Senegal]

PURPOSE

Attempting to improve life expectancy among diabetics reveals degenerative complications, including diabetic retinopathy (DR) linked to microangiopathy. We assessed the incidence of diabetic retinopathy in its various forms amongst diabetics in Senegal.

PATIENTS AND METHODS

We carried out a survey between March and October 1998. The 51 patients surveyed had been affected for more than 5 years. They were divided into two groups: insulin-dependent diabetes (IDD) and non-insulin-dependent diabetes (NIDD). Patients were aged 17-71 and included 27 IDD and 24 NIDD. Each patient was given both a biological checkup (blood sugar level, HBA1c, creatininemy, triglycerides, cholesterol, albuminaria and urinary glucose) and an ophthalmological checkup with angiography in fluorescence.

RESULTS

Of the 51 patients studied, 26 presented a progression span of the disease of over 10 years. DR was detected in 62 eyes out of 102 (60.78%), with 37.25% of nonproliferating DR, 17.65% of preproliferating DR, and 5.88% of proliferating DR. Maculopathy was detected in 10 eyes (9.80%). Amongst the IDD patients, diabetic retinopathy accounted for 57.14% of diabetes, with a progression span of less than 10 years, compared to 84.62% for diabetes with a progression span of over 10 years. Amongst the NIDD patients, diabetic retinopathy accounted for 36.36% compared to 61.54%.

DISCUSSION

Through these results, a connection can be made between diabetic retinopathy, the progression span of diabetes, the type of diabetes, and the other microangiopathies. We noted a rise in retinopathy that increased with the age of diabetes patients and their IDD group.

CONCLUSION

A multidisciplinary support of diabetes ensures early detection of diabetic retinopathy; hence the need for closer collaboration between the endocrinologist and the ophthalmologist.

[Prevalence of diabetic retinopathy at the Dakar University Hospital Center]

The aim of the study is to appreciate the prevalence of diabetic retinopathy among senegalese patients in analyzing age of diagnosis, duration of diabetes, plasma glucose and type of retinopathy. 129 diabetics followed and treated in the diabetic center of internal medicine clinic (Dakar University) were examined by 90 degrees Volk's lens. A determination of plasma c peptide and glucose concentration were performed. 55 (mean age 224. +/- 0.9 years) were insulino-dependent and 74 (mean age of 54.7 +/- 11.4 years) non insulinodependent. On average the duration of diabetes was 5.4 years +/- 5.4 for the former and 6.07 +/- 5.7 for the latter with respectively glucose plasma average 2.60 g/l +/- 0.7 and 1.7 g/l +/- 0.83. Retinopathy was found in 29 patients. So total prevalence was 22.48%, shared in 29.7% for non insulino-dependant and 12.7% for insulino-dependent. In 7 cases the retinopathy was proliferative and non proliferative in 22 cases essentially among non insulino-dependant diabetics. The diabetic retinopathy is one of handicaping complications of diabetics. Its prevalence is strongly linked to the duration of diabetes, glycaemic control and to other risk factors (genetics, glycosylated hemoglobin and high blood pressure).

[Contribution of the Kansas technique for reducing complications of mature cataract surgery]

PURPOSE

We report our experience with the Kansas technique of phakosection which eliminates or limits most complications of classic manual extracapsular extraction.

PATIENTS AND METHODS

This retrospective study included our first 80 patients undergoing surgery for mature cataract between May 1996 and May 1998 where we used the Kansas technique. We compared outcome with a group of 30 patients who underwent classic manual extracapsular extraction in a study performed in 1995 by the same surgeon in the same hospital.

RESULTS

Per- and post-operative complications were significantly lower with phakosection. Functional rehabilitation was quicker, better and provided better patient comfort.

DISCUSSION

Despite some difficulties encountered in a public hospital (viscoelastic excessively fluid and in small quantity, lack of suitable knives or reuse of sterilized disposable knives), we found that the Kansas technique is very well adapted to mature cataracts and our working conditions.

CONCLUSION

Phakosection allowed us to give our patients with mature or very mature cataracts the benefit of small incisions. With a moderate increase in cost, this technique significantly reduced our per- and post-operative complication rates and gave quicker and better visual recovery. In our countries, this technique provides better care than phakoemulsification.

[Idiopathic serous retinal pigment epithelial detachment (a case report)]

Retinal pigmented epithelium detachment is frequently associated to age related macular degeneration or others maculopathies. More rarely no cause can be found, particularly in young patients where it constitutes an entity named "Idiopathic serous detachment of the retinal pigmentary epithelium". We report such a case. We insist on the clinical and angiographical characteristics which allows a differentiation from the idiopathic central serous chorioretinopathy with which it can be confused. Last, it is important to point that for the time being no treatment can shorten the evolution.

[Analysis of implant position after envelope technique in "white" cataract surgery]

Capsulopunture in cataract surgery doesn't allow insertion of intraocular lens in the capsular bag. Envelope technique is a easy way for this insertion. The goal of our study was to analyse the position of the intraocular lens in the capsular bag, after performing envelope technique in eyes suffering from "white" cataract. We realised on 25 eyes with "white" cataract, envelope technique. GALAND method (one superior linear capsulotomy) was realised in 15 cases and double linear capsulotomy (superior and inferior), was realised in 10 cases. The mean age of our patients was 55 years with two extremes (17 and 70 years). The mean visual acuity was 14/20. After verification, in 91.636% eyes, intraocular lenses were in the capsular bag. In 2 cases, we found a decentration. Envelope technique can lessen risks of capsular zip. It protects endothelium cells and is helpful for the insertion of the intraocular lens in the capsular bag. Envelope technique is well adapted to the surgery of "White" Cataract.

[Vitreo-retinal complications of hemoglobinopathy SC]

Sickle hemoglobinopathies are frequent in black population. Double heterozygous SC gives less general symptoms but ocular complications are very common. Fluorescein angiography of 20 cases are reported. All the patients had hemoglobin electrophoresis showing double heterozygous SC. Clinical investigations included fundus examination and fluorescein angiography. Laser treatment or cryotherapy were realised regarding lesions features. Vascular retinal complications were found in 75% of cases, including vitreous hemorrhage (10% of cases). There was no correlation between fundus examination and fluorescein angiography. Fluorescein angiography is useful for early diagnosis and allows preventive laser treatment.