[Health-care related infections in pediatric surgery of the teaching hospital Gabriel Toure, Bamako, Mali]

OBJECTIVES

to identify the main causative agents of infection associated with care and their susceptibility to antibiotics used and to identify risk factors for care-associated infection.

MATERIAL AND METHODS

This was a cross-sectional study with prospective data collection, conducted from 1 November 2016 to 1 April 2017 among all children admitted to the pediatric surgery department. Non-consenting parents and cases of necrosectomy were included in this study.

RESULTS

Our study involved 200 patients, 30 of whom presented a care-associated infection (15% infection rate). The average age of patients with infection was 56.33 ± 48.66 months (1 and 180 months). The main pathogens responsible for infection of the operative site were: Escherischia coli (4 cases), Acinetobacterbaumanii (3 cases), Klebsiella pneumoniae (2 cases), Staphylococcus aureus (2 cases), Enterobacter cloacae (1case), Pseudomonas aeruginosa (1 case) and Enterobacter faecalis (1 case). In the burned patients, the organisms found were: Acinetobacter baumanii (7 cases), Klebsiella pneumoniae (6 cases), Staphylococcus aureus (6 cases), Escherischia coli (4 cases), Pseudomonas aeruginosa (2 cases) and Enterobacter faecalis (2 cases). Escherichia coli was noted in urinary tract infection. Antibiotics tested were amoxicillin, amoxicillin-clavulanic acid, ceftriaxone, imipenem, gentamicin and ciprofloxacin. The mode of recruitment and the duration of hospitalization were the risk factors noted.

CONCLUSION

The infection associated with care is a frequent occurrence in our practice. These infections mainly occur at the operating sites. The germs found were: Acinetobacter, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus. They are all sensitive to imipenem and resistant to amoxicillin. The infection remains formidable in health care. It is essential to give special attention to the prevention of infectious risk, especially in the surgical setting.

[The therapeutic itinerapy of epileptics admitted by the Electoencephalographic Laboratory at CHU Dakar]

In Senegal, as in other under developed countries, the delays before seeking medical treatment are long varying from 2 to 12 according to studies. This is related to the fact that in traditional African communities, prejudices and believes delayed medical management which is seeked after failure of traditionnal treatments. The objectives of this study concerning therapeutic itinerary of epileptics in the EEG laboratory at the Neurology Department at CHU in Dakar were to evaluate the average latency of medical consultation and to identify the recourse path by patients receiving antiepileptic treatment. We conducted from March to may 2001, a cross disciplinary study, with a sample size of 212 patients. 79.2% of patients were less than 30 years old. They first seek treatment in hospitals in 36.8%, traditional practionners in 35.8%, health centers in 23%, and private clinics in 4%. The average delay of treatment in modern structures was by 13.4 +/- 4.7 months. The towards the healers was linked to faulty beliefs in 61.8% of the cases, lack of information (22.4%), or a lack of financial means (2.6%). The patients were refeared to traditional healers in 6.7% of the cases for reasons of confidence in traditional medecine. The orientation to neurology clinic was recommended by health personal in 83% of the cases, family (14.6%), or the healer (1.4%). The long and difficult journey of epileptics in Senegal remains marked by exclusion, absence or delay of medical attention.

[Diagnosis delay of multiple myeloma: report of 22 cases in an internal medicine department of Dakar]

Reported is a retrospective study conducted on in patients with multiple myeloma diagnosed from January 1990 to December 2000 in the departement of Internal Medicine I of Dakar University Hospital. Twenty-two patients were included. The mean age was 55 years (range 29-76). The sex ratio (male to female) was 2.6 (they were 16 males and 6 females). The presenting clinical features were dominated by bone manifestations with diffuse pain (41%) followed by pathologic fractures (22.27%) and lumbar pain (13.6%). At the hospital admission the type of clinical manifestations recorded were related to bone (91% general (60%), neurologic (36%) and infection (36%). The biological exams documented an anemia in 20 cases (91%) and increased serum protein in 13 cases (59%) and hypercalcemia in 11 cases (50%) and renal insufficiency in 6 cases (27%). Immunoelectrophoresis had been performed in 6 cases and revaled 4 cases of IgG and 2 cases of light chain myeloma. On the skeletal radiological exams it has been found lytic bone lesions in 66.6 % of cases. diffuse bone rarefaction (38.88%), pathological fractures (38.88%) and vertebral collapses (18.18%). The bone marrow aspiration showed in 17 cases over 19 a medullary dystrophic plasmocytosis. According to the Salmon and Durie classification 68% of the patients were pointed in stage III. Comparing our results to the series, we figure out our patients younger at the time of the diagnosis and an important diagnosis delay as previously suggested in the African litterature. This is confirmed by the fact that 68% of patients were one Salmon and Durie stage III. the frequency of severe anemia and pathological fractures We invite practitionners to conduct systematic exploration of mild symptoms like lumbar pain.

Persistence of circulating complexes between HBsAg and immunoglobulin M in sera of hepatitis B surface antigen positive patients suffering from liver cirrhosis or primary liver cancer

Complexes between hepatitis B surface antigen (HBsAg) and immunoglobulin M (IgM) have been detected in acute type B hepatitis. Sequential serum testing for the presence of these complexes has been shown to be the best method for predicting disease chronicity. The presence of HBsAg/IgM complexes was investigated using an enzyme-linked immunosorbent assay with selected sera from Senegal. The three population groups studied were composed of 405 Senegalese soldiers as well as 84 liver cirrhosis and 169 primary liver cancer patients. Only one of the 122 HBsAg negative sera tested was found to be positive for HBsAg/IgM complexes. Complexes were detected 13.9% of the HBsAg positive soldiers, in 40% of the HBsAg positive liver cirrhosis patients, and in 50% of the HBsAg positive primary liver cancer patients. HBsAg/IgM complexes were also detected in 53.6% of the hepatitis B e antigen (HBe) positive soldiers, compared to 75 and 76% for the HBeAg positive liver cirrhosis and primary liver cancer patients, respectively. In anti-HBe positive sera, an increased proportion of HBsAg/IgM complexes was observed during the sequence chronic hepatitis (5%)-cirrhosis (29%)-primary liver cancer (42%). On the other hand, it has been reported that in the sequence of events leading from chronic hepatitis to primary liver cancer, there is an increase in anti-HBeAg prevalence and in alpha-fetoprotein levels. In this study, only alpha-fetoprotein levels were found to increase. Values higher than 15 IU/ml were observed in 4.3, 27.3, and 86.4% of the HBsAg positive individuals from the three groups. No significant variation was observed in the anti-HBe prevalence between the population group (64-75%).