Human biomonitoring guidance values (HBM-GVs) for priority substances under the HBM4EU initiative - New values derivation for deltamethrin and cyfluthrin and overall results

The European Initiative HBM4EU aimed to further establish human biomonitoring across Europe as an important tool for determining population exposure to chemicals and as part of health-related risk assessments, thus making it applicable for policy advice. Not only should analytical methods and survey design be harmonized and quality assured, but also the evaluation of human biomonitoring data. For the health-related interpretation of the data within HBM4EU, a strategy for deriving health-based human biomonitoring guidance values (HBM-GVs) for both the general population and workers was agreed on. On this basis, HBM-GVs for exposure biomarkers of 1,2-cyclohexane dicarboxylic acid diisononyl ester (DINCH), phthalates (diethyl hexyl phthalate (DEHP), di-n-butyl phthalate (DnBP), diisobutyl phthalate (DiBP), butyl benzyl phthalate (BBzP), and bis-(2-propylheptyl) phthalate (DPHP)), bisphenols A and S, pyrethroids (deltamethrin and cyfluthrin), solvents (1-methyl-2-pyrrolidone (NMP), 1-ethylpyrrolidin-2-one (NEP), N-dimethylformamide (DMF), N,N-dimethylacetamide (DMAC)), the heavy metal cadmium and the mycotoxin deoxynivalenol (DON) were developed and assigned a level of confidence. The approach to HBM-GV derivations, results, and limitations in data interpretation with special focus on the pyrethroids are presented in this paper.

[Surgical options in the treatment of noma]

In the acute phase of noma, the role of surgery is minor and the treatment consists in the realisation of local or regional flaps and sometimes the management of haemorragia. For reasons social and economic reconstruction of the loss of substance should be conducted on site. The treatment consists of surgical excision of fibrous tissue, the removal of the ankylosis and the closure of the PDS by local flaps, or free pediculated. Because of the extreme variety of loss of substance (PDS) and the multiple surgical options, a systematic and eventually, the standardization of the surgical approach in the treatment of sequelae of noma is essential.

[Volvulus of sigmoid colon: surgical treatment and prognosis in the services of General Surgery of the Point G Teaching Hospital]

OBJECTIVE

To study the therapeutic aspects and prognosis of volvulus of the sigmoid colon in surgical departments.

PATIENTS AND METHODS

Our study was retrospective from January 2000 to December 2009 (10 years). All patients who underwent sigmoid volvulus in the Point G teaching hospital surgical departments were taken into account.

RESULTS

We recorded 96 patients operated for volvulus of sigmoid over 882 cases of bowel obstruction, a rate of 10.9%. The average age was 47.2 years ± 18.9. In per-operative, there was a necrosis of the colon rate of 16.7% (14 cases). Performed surgical treatment modalities were: sigmoidectomy with primary anastomosis in 29.2% of cases (28), sigmoidectomy followed by colostomy and secondary anastomosis in 60.4% of patients (58) and 10.4% rare of simple devolvulation. The immediate postoperative period were marked by a morbidity rate of 7.3% (7 cases) and a mortality rate of 7.3% (7 cases).

CONCLUSION

In spite of various therapeutic modalities of volvulus of the sigmoid colon, the rates of postoperative morbidity and mortality are rising in the general surgery of the Point G teaching Hospital.

[Postoperative Pains: Evaluation Of Its Management In The Point G Teaching Hospital]

OBJECTIVE

To evaluate the management of postoperative pain in the Point G teaching hospital.

PATIENTS AND METHODS

We carried out a prospective study, in 2008. Inclusion criteria for the personnel: be a staff member from the department of surgery or anaesthesia reanimation; willing to fill out the questionnaire. Inclusion criteria for patients: to be operated and hospitalized in one of the departments of surgery and anaesthesia reanimation.

RESULTS

We collated the responses of 600 patients and 113 personnel. 92% of the patients underwent post-operative analgesia. The delay between the request and treatment of the patient was extensive in 92% of cases. The medical personnel and nursing staff had not received specific training on treating the pain in respectively 55% and 70% of cases. We noted an absence of informational support and of pre-established consensual protocols, written and validated on the management of postoperative pains.

CONCLUSION

The treatment of the postoperative pains shows important shortcomings within the Point G teaching hospital and these insufficiencies are found across levels.

[Common mesentery: discovered two cases of intestinal obstruction]

The purpose of this study was to describe the common mesentery in its occlusive form and practice driving before this emergency. The mesentery is a common abnormality of rotation of the primitive intestinal loop or omphalomesenteric loop during embryonic development. Two cases of intestinal obstruction by strangulation were received in urgency. They were a 55 year old man who checked himself into the emergency department and a 14 year old girl brought in by her parents. These were 2 cases of acute intestinal obstruction on incomplete common mesentery. The intestine was turned to complete common mesentery in both cases. Embryologically, it is anomalies of rotation and joining of the primitive intestine that are causing the incomplete common mesentery , the source of acute intestinal obstruction due to strangulation.

CONCLUSION

The common mesentery poses a diagnostic and therapeutic problem. Its symptomatology is that of occlusion by strangulation and the surgeon must note this before any obstruction.

[Postoperative peritonitis in the Surgery B department of the Point G hospital]

OBJECTIVE

To determine the incidence of postoperative peritonitis, and describe their clinical, paraclinical and therapeutic aspects.

PATIENTS AND METHODS

This was a retrospective study conducted between 1980 and 2010 in the Department of Surgery B of the Point G University Hospital. It focused on all patients who underwent surgical intra-abdominal in the Surgery B department.

RESULTS

We collected 25 cases of postoperative peritonitis, 84% were male subjects. The average age of patients was 37.2 years ± 17.0. The clinical picture was dominated by abdominal pain (92%), abdominal defense (92%), and fever (84%). Abdominal ultrasound played an important role in diagnosing 72% of cases. Etiologies were dominated by anastomotic leak (32%), infection of the collection phrenic, iatrogenic perforation (28%). Interventions made at surgery were: suture of the perforation or anastomotic recovery plus peritoneal cleansing and drainage in 36% of cases, peritoneal cleansing and drainage in 36%. There were postoperative complications in five patients. The mortality rate was 4%.

CONCLUSION

Postoperative peritonitis are rare in our service. When they occur their rate of morbidity and mortality are high.

[Peritonitis by typhoid ileal perforation: evolutionary aspects in the Teaching Hospital of Bamako and Kati in Mali]

OBJECTIVE

The objective of this study was to determine the frequency of peritonitis by typhoid ileal perforation in the teaching hospitals of Bamako and Kati.

PATIENTS AND METHODS

We conducted a retrospective study over a 24 years period (1984-2007). Every patient admitted and operated in urgency for peritonitis by ileal perforation were listed and included in this study.

RESULTS

During the study period, 1868 acute peritonitis were operated on in the three major health centres of Bamako and Kati. We collected data concerning 543 typhoid ileal perforations which represented 29.0% of all peritonitis. The peritonitis by typhoid perforation constituted 28.5% of the peritonitis in the teaching hospital of the Point G, 30.6% in the Gabriel Touré teaching hospital and 6.4% in the teaching hospital of Kati. Among the peritonitis by typhoid perforation, 56.7% were listed in the Point G teaching hospital, 43.0% in the Gabriel Torre teaching hospital and 0.3% in the Kati teaching hospital. Between 1984-2004 we collected data from two hundred and fifty seven (257) patients suffering from peritonitis by typhoid ileal perforation, a total of 24.4% of the peritonitis recorded. Between 2005-2007, the data for two hundred eighty six (286) patients suffering from peritonitis by typhoid ileal perforation was collected, a total of 35% of the peritonitis recorded. The typhoid ileum perforation remains the 2nd overall cause of generalized peritonitis after that of appendicular origin.

CONCLUSION

Peritonitis by typhoid ileum perforation has seen a significant increase from 2004 in the teaching hospitals of Bamako and Kati.

[The size of the bile duct by echograph. A study]

The purpose of this work was to determine the size of the bile duct by echograph. The frequent injuries of the bile duct in various pathologies in particular infection, made of it a very investigated organ especially by echograph. Its size can be modified by various pathologies. So it is of interest to know about its normal size.

PATIENTS AND METHOD

Sixty normal subjects, among which 29 women, were examined by echograph in the university hospital of the Point G. They were voluntary subjects with an empty stomach for 12 hours. Three different sonographers successively performed this examination according to the same protocol with an Aloka SSD 1700 device type and a Kontron Medical/Imagic Maestro. These devices were provided with a convex probe of 3.5-megahertz multifrequency and with a linear probe of 7.5-megahertz. The subjects were in dorsal position. Reference points for the display of the bile duct were the liver, the gallbladder and the pancreas. The limits of the bile duct were marked by the cursor of the echograph. The transverse diameter (in mm) of the bile duct was measured in its origin and in its ending. No subject of the sample was obese enough to hamper the visibility of the gall-bladder and the bile duct and no subject had histories of cholecystectomy. Data analysis was made using the software Ear information version 6. The difference between variables was considered as significant when P<0,05.

RESULTS

Forty subjects out of 60 were between 20 and 39 years old. The transverse diameter of the bile duct was measured 38 times (63.3%) in its origin and 50 times (83.3%) in its ending. The failure of visibility of the proximal segment was 37.7% and the failure of visibility of the distal segment of the bile duct was 17.7%. The average transverse diameter of the bile duct in its origin was 2.61.4 mm; extremes were 2 and 5 mm. The average transverse diameter of the bile duct in its ending was 3.10.7 mm; extremes were 2 and 5 mm. The transverse diameter of the bile duct in its origin of the subjects was contained between 3 and 4 mm in 80% of the cases. The transverse diameter of the bile duct in its ending of the subjects was contained between 3 and 4 mm in 40% of the cases. The difference was very significant between the diameter of the bile duct in its origin and in its ending (P<10(-6)).

CONCLUSION

The distal segment of the bile duct was seen more accurately than the proximal segment by echograph. The diameter of the bile duct in its ending was significantly superior to that of the bile duct in its origin.

[Factors affecting nosocomial infection in the surgery setting at the Hospital of Point "G"]

Nosocomial infections are a common and increasing problem globally, and particularly in Africa. The significant economic burden of these infections on the health care system as well as their impact on patient morbidity and mortality is well recognised within the medical communities.The goal of this study was to investigate factors that influence nosocomial infection in all in-patients from the surgery wards (surgery ward A and B, Gynoeco-obstetrics, urology and intensive care) at the national hospital of Point G in Bamako, Mali. We report the number of nosocomial infection during a prospective study between June 2003 and January 2004. Of 1043 in-patients, 102 had had a nosocomial infection with a global prevalence of 9.7% (8.0-11.4). Of 1024 patients with surgery, 101 had had a nosocomial infection, a post-surgery nosocomial infection rate of 9.8% (8.1-11.5). We observed different site of nosocomial infection such as suppuration sup-aponevrotics (41.2%), parietal infection sub-aponevrotics (32.4%), urinary infection (17.6%) and organ suppuration (3.9%). Other nosocomial infection observed were pneumonia (2.9%) and catheterisation (2.0%). The nosocomial infection rate was 10.3% in male while it was 7.3% in female. The difference between male and female was not statistically significative (chi2 = 2.33, p = 0.12). Nosocomial infection was more prevalent in patients after emergency surgery (15.1%) than in scheduled surgery patients (8.5%) (chi2 = 8.15, p = 0.004). The classes III and IV of ALTEMEIER had the higher proportion of nosocomial infection (35.9%) against 4.8% for the classes I and II (chi2 = 144.95, p < 0.001). The patients with ASA score I had a lower nosocomial infection rate than patients from the intensive care unit or patients of Class II + III + IV (chi2 = 13.2, p = 0.001). Patients classified according to the National Nosocomial Infection Surveillance System (NNISS) with a score 0 had a nosocomial infection rate less than patients classified as NNISS score 1, 2 or 3 (chi2 = 82.0, p < 0.001). The study results underline the need for further investigations of the role of microbial agents and antimicrobial resistance in the outcome of patients with nosocomial infection.

[Etiology of pleurisy in the Service of Pneumology, Point G]

This study describes epidemiologic, etiologic and evaluative aspects of Pleurisy pneumology department of Point "G". From 1st January 1998 to 31 December 2002 was realised a study about hospitalized patients in the department. Pleurisy represented 15; 9% of hospitalizations. The sex Ratio was 2,3 en for men aged of 41 years 55 of pleurisy were located on right. In 60% of cases the liquid was sero-fibrin, purulent in 25% of cases and haemorrhagic in 15%. Tuberculosis was the most frequent etiology with 37% of cases. According to liquid aspect tuberculosis represented 54, 3% of sero-fibrin pleurisy in one hand, on the other 60% of haemorrhagic pleurisy was due to cancer. The serology HIV have been realised on 89 patients and it was positive on 56% of cases. Association pleurisy/HIV tuberculosis etiology represented 56% of cases. Among 369 patients we have counted 100 deaths, 27% and 86% of these death occurred before a month of hospitalization. Even if the prevalence of neoplastic pleurisy increases, tuberculosis still the 1st etiology of pleurisy. It co-infection with HIV is the principal cause of morbidity and mortality.

[Problems with lung cancer in the pneumology service at G Barnako Hospital, Mali]

The authors report the results of a retrospective study on the bronchial cancers observed in the service of PPH of the hospital of the point G of Bamako during the time active of January 1, 1999 to December 31, 2003. The goal was to describe the epidemiological, clinical and therapeutic aspects of bronchial cancer On 669 in-patients, 36 cases of bronchial cancer were diagnosed either a prevalence of 5.36%. the average age of the patients was 54.5 years with the extreme ones going from 35 to 80 years. Our series was made up of 27 men and 9 women with a sex ratio of 3 in favor of the men. The nicotinic was the principal factor of risk (69.4%) with an average of 20,9 packages year. The mode of prevalent nicotinic was the cigarette (92%). The functional signs most frequent were the thoracic pain (72.2%); cough (56.6%); dyspnea (22.2%). The histological type was found in 19.4% of the cases, carcinomas épidermoíde were more frequents (42.9%). 93.4% of the patients had profited only from one palliative treatment. Bronchial cancer poses enormous problems with the experts of the countries under equipped. Its appalling forecast is related to the delays and insufficiencies diagnostic and therapeutic

[Not Available]

It is about a 77 years old man admitted for a small hemoptysia and a tuberculosis history that hemoptysia had been developing in a context of 38,5 0 c fever plus some crepitate rales in the right pulmonary area. After tuberculosis has been eliminated trough the bacilloscopy procedure, investigations of aspergillus in the splits have been negative. A pulmonary x ray revealed a retractile standard opacity in right pulmonary area. Amoxicilline based treatment has been conducted for two weeks in vain. Finally the pulmonary aspergillosis diagnosis pulmonary was then accepted following highly positive aspergillary serology.

[Portal vein: echographic anatomy]

The principal descriptions of the portal vein are mainly on the results of the dissections of the corpses. The aim of the work was to determine the usual sizes of the portal vein on the alive subject by echography. From the same machine, 3 ultrasonographers studied the anatomy of the portal vein of the volunteers according to a standardized methodology. The study was about 60 old people from 11 to 82 years old, whom 31 were males (51.7%) and 29 females (48.3%). The transverse diameter of the portal vein, originally varied between 8 and 10 mms un 57.9% of cases. The average was 9.05 mms +/- 2.82 and the extremes varied from 5 to 16 mm. The transverse diameter of the portal vein, at the end varied between 8 and 10 mms. The average was 9.16 mms +/- 2.58 and the extremes varied between 6 and 16 mms. In 29.8% of cases, the length of the portal vein was between 61 and 70 mms and in 8.8% between 81 and 100 mms. The average was 58.0 +/- 22.3 mms. Before its entry into the liver, the portal vein is divided into 3 branches in 2 cases (3.3%). The study showed a significant change of the length of the portal vein according the age and sex.