[Cystic meningioma of falx cerebri: About one case and literature review]

Cystic meningioma of the falx is a rare extra-axial tumor, representing 4 to 7% of all intracranial meningioma. We report the case of a 23 years old patient with relative personal health history who has presented for nearly two years generalized headache associated with left hemiparesis. The head CT scan and MRI showed a right posterior parietal tumor with a cystic and fleshy component which was interpreted as glioma. The patient was operated and the intraoperative aspect was an extra axial lesion inserted to the middle tier of the falx cerebri with a clear cleavage plan with the cerebrum. A total ablation of the lesion was down and the histological study confirm the diagnosis. The cystic meningioma is a rare variant of intracerebral meningioma of which only histology makes it possible give the diagnosis of certainty.

[Endoscopic surgery and covid 19 disease: case report]

The objective of this work is to raise the issue of contamination of covid 19 disease during endoscopic endonasal surgery for pituitary tumor. This is a 32-year-old patient with a body mass index at 49,38 seen in an outpatient clinic for headache, erectile dysfunction and gynecomania, a CT scan revealed a pituitary macroadenoma. The preoperative workup was unremarkable including the rapid polymerase chain reaction (PCR) test was negative. The endonasal approach was decided for surgery. The tumor was removed by aspiration. The postoperative course was straightforward until the fifth day when the patient presented a dry cough with a fever at 38 ° 5 associated to respiratory discomfort. The thoracic CT-scan showed "ground glass" opacities located at peripheral and bilateral, and essentially posterior suggesting covid 19 disease. A second test was performed. Before the result, the anticoagulant treatment associated with third generation cephalosporin was done. The test results came back after 72 hours and was positive. Azithromycin, hydroxychloroquine, and oral vitamin C have been used for 11 days. The outcome was favorable and the patient was discharged from the hospital on the twelfth day after the negative PCR test.

[Diagnosis and surgical traitment of intracerebral hydatic cyst in Mali]

AIMS

Cerebral hydatic cysts are common in North African and pastoral countries but still underdiagnosed in sub-saharian ones.We report the first two casesoperated in Mali andhistologically proven of cerebral hydatic cysts.

PATIENTS AND METHOD

Our study was aboutabout a 46 years old patient, admitted for Bravais-Jacksonian crisis, dysarthry and right hemiparesy, and another 38 years old male one, with a intracranial hypertension syndrome associated with cranial fistulized cerebral hydatic cyst.The CT scan has shown a cerebral cyst in the first case and multi-locular cysts in the second. The patients underwent surgery, with complete removal in one case and a rupture in the second case, but with a good outcome. Anatomo-pathological analysis concluded to hydatic cerebral cysts in both cases.

CONCLUSION

With these first cases, the diagnosis of cerebral hydatic cyst must be evoked more frequently in our countries, because of the evolution of radiological diagnosis and surgical abilities.

[Healthcare associated infections in the neurosurgical department of Gabriel Touré teaching Hospital in Bamako]

INTRODUCTION

Healthcare-associated infections or nosocomial infections are a public health problem due to their frequency, severity and economic impact. They cause an increase of the morbidity, the mortality, the hospital stay and the expenses of taking care of the patients. According to the WHO, 7.1 million people are affected each year, of which about 100,000 die.

AIM OF STUDY

The aim of this study was to determine the frequency of healthcare-associated infections in the Neurosurgery Department of Gabriel Touré University teaching Hospital and to identify the risk factors associated with these infections.

MATERIAL AND METHODS

This was an epidemiological, descriptive, analytic, cross-sectional and prospective study lasting 6 months from May 29 to November 30, 2016. The study focused on patients who stayed more than 48 hours in the Neurosurgical department Gabriel Touré teaching hospital. The collected data focused on the clinical and biological characteristics of the patients during their hospitalization. The maximum size of the sample was 200 patients. A sample was taken for each type of infection. The criteria used for the diagnosis of Healthcare-associated infections were those of the CDC (Center for Disease Control) and the realization of a thick drop in our context. The chi-square test was used for the comparison of qualitative variables and Kruskal Wallis and Anova for quantitative variables. The materiality threshold has been set to a value of p less than 0.05.

RESULTS

At the end of our study, we had 34 infected patients out of 200, a rate of 17%. The significant risk factors found in our study were: high age (p = 0.04), ASA class (p = 0.002), pre-surgical shaving (p = 0.02), long duration surgical intervention (p = 0.002) and long hospital stay (p = 0.004). The types of infections associated with the care found were: urinary in 18 (53%) cases, respiratory in 9 (26%) cases, operative site in 6 (18%) cases and 1 (3%) cases of bacteremia. The bacterial spectrum of these infections was dominated by Negative Gram Bacilli, among which Escherichia coli in 11 (32.3%) cases. The clinical course of patients treated for these infections was marked by healing in 31 (91.2%) cases, complications in 2 (5.9%) cases, and death in 1 (2.9%) case.

CONCLUSION

The prevalence of Healthcare-associated infections in our department remains high compared to that found in developed countries. This study allowed us to identify the main risk factors associated with these infections. A stricter adherence to the rules of hygiene and prevention of Healthcare-associated infections is needed to reduce this rate.

Short duration of untreated psychosis enhances negative symptom remission in extended early intervention service for psychosis

OBJECTIVE

To test whether duration of untreated psychosis (DUP) < 3 months, recommended by the World Health Organization/International Early Psychosis Association, enhances the effects of an extended early intervention service (EEIS) on symptom remission.

METHOD

We examined data from a randomized controlled trial in which patients who received 2 years of treatment in EIS for psychosis were subsequently randomized to either 3 years of EEIS or 3 years of regular care (RC). Using a DUP cut-off ≤ 12 weeks (approximately < 3 months), patients were split into two groups. Length of positive, negative and total symptom remission were the outcomes.

RESULTS

Patients (N = 217) were mostly male (68%) with schizophrenia spectrum disorder (65%); 108 (50%) received EEIS (58 had DUP ≤12 weeks; 50 had DUP >12 weeks). Interaction between treatment condition (EEIS vs. RC) and DUP cut-off ≤ 12 weeks was only significant in multiple linear regression model examining length of negative symptom remission as the outcome (adjusted β = 36.88 [SE = 15.88], t = 2.32, P = 0.02). EEIS patients with DUP ≤12 weeks achieved 25 more weeks of negative symptom remission than EEIS patients with DUP >12 weeks.

CONCLUSION

Having a short DUP may be critical in deriving long-term benefits from EIS for psychosis, including EEIS settings. This work empirically supports policy recommendations of reducing DUP <3 months.

Giant occipital meningohydroencephalocele in an adult: Another historical case in neural tube defects

Meningohydroencephalocele is a herniation of meninges, cerebrospinal fluid, brain parenchyma and a part of the ventricular system through a bony defect in the skull. This bone defect may be congenital, spontaneous or traumatic in origin. The lesions are mostly congenital, discovered generally after birth or in very young infants. We report the first historical case of the entity in this location in a 29-year-old man and discuss the pathogenesis, surgical management and social considerations of this type of neural tube defect in our country.

[Epidemiological, clinical and therapeutical study of depressed skull fractures in the neurosurgical department of the gabriel toure hospital: about 72 cases]

INTRODUCTION

Depressed skull fractures are common and frequent among neurosurgical diseases of whose danger stem from the associated intracranial lesions. The aims of this study were to describe the epidemiological characteristics of depressed skull fractures, to determine their etiology, to describe the clinical signs, to highlight the complications and sequelae and to evaluate care management.

PATIENTS AND METHODS

It was a retrospective and descriptive study from January to December 2013 including 72 patients admitted to the neurosurgical department of the Gabriel Toure hospital.

RESULTS

The frequency was 14.7% and the male to female ratio was 13.4. The peak frequency of these injuries occurred in the 16-to 25-year-old age group accounting for 38.9% of cases. Road traffic accidents were the most common causes of depressed skull fractures (59.7%). Neurosurgical treatment was performed in 25 (34.72%) patients and the most common surgical technique performed was the craniectomy in (64%). Infection of the wound was found in 15.3% and the mortality rate was 1.39%.

CONCLUSIONS

Depressed skull fractures are a frequent neurosurgical disease in the Gabriel Touré hospital. Young people are most affected and road traffic accidents involving motorbikes are the main cause the fractures. The infection of the wound is a poor prognostic factor. Therefore, an early management is required to expect a good outcome.

[Clinical and therapeutical aspects of lumbar stenosis in the gabriel touré hospital: about 24 cases]

INTRODUCTION

Lumbar stenosis is a disease caused by a conflict between the neural structures (spinal cord and nerve roots) and spinal structures (bones and ligaments). The objectives of this study were to highlight the frequency, the diagnosis and therapeutics options, and to evaluate the treatment outcomes.

PATIENTS AND METHODS

It was a retrospective study from January 2012 to December 2012 including 24 patients admitted to the neurosurgical department of the Gabriel Touré Hospital.

RESULTS

The frequency of lumbar stenosis was 6.19% of all neurosurgical diseases. The sex-ratio was 0.71. The age ranged from 28 to 81 years with an average of 52 years. The neurogenic claudication was found in 87.5%. The straight leg raising test was positive in 41.7% of cases. The most vertebras involved were L4 and L5. Lumbar disc herniation was associated in 70.83%. Degenerative lumbar stenosis was the most common form, found in 66.67% of cases. Surgical treatment was performed in 29.17% of cases. The outcome was good in 85.6% of cases.

CONCLUSIONS

Lumbar stenosis is a prevalent disease that occurs typically occurs around 50 years of age. The diagnosis was confirmed by myelography and a post myelographic CT scan. Good outcomes are achieved with both surgical or medical treatments.

A compliance and satisfaction with home exercise: a comparison of computer-assisted video instruction and routine rehabilitation practice

Computerized educational technology, in various forms, is permeating the health care setting, and clinicians and program managers are charged with evaluating its potential to improve patient health outcomes. The purpose of this randomized controlled trial was to compare two alternative methods of therapeutic exercise instruction in a sample of orthopedic rehabilitation patients (n = 40). The traditional (control) group received routine inpatient rehabilitation exercise education from physical therapists (using demonstrations, verbal feedback, and written materials), and the technology (intervention) group received routine care as described plus one additional therapeutic session in which a customized set of exercises was downloaded from a computerized database to videotape by each patient's therapist and given to the patient for continued use at home. Data on patient compliance and patient satisfaction were collected at patient discharge and at four-week follow-up using a questionnaire designed specifically for this study. Analysis of results showed no significant differences in patient compliance or patient satisfaction between the two study groups. Results of this randomized trial suggest that computerized patient education technology may not provide the benefits anticipated.

Dracunculiasis in Cameroon at the threshold of elimination

BACKGROUND

Dracunculiasis is endemic in Mayo Sava Division in the Far North Province of Cameroon. Transmission occurs during the rainy season with a peak in the months of July and August.

METHODS

A combination of interventions consisting of active surveillance, social mobilization, health education, distribution of filters, construction of new water sources, chemical treatment of unsafe water sources with temephos, and case containment were applied in Mayo Sava in 1990-1995 by the national Guinea Worm Elimination Programme (GWEP). Dracunculiasis cases were detected by village health workers, confirmed by health outreach teams and reported weekly to the GWEP.

RESULTS

A decline in the incidence of dracunculiasis by 98.1% from 778 cases in 1990 to 15 in 1995, and in the number of endemic villages by 92.7% from 82 in 1990 to 6 in 1995 was achieved. The proportion of cases identified < or =24 hours of worm emergence increased from 19% in 1991 to 73.6% in 1993. Over 1500 nylon monofilament filters were distributed yearly to endemic villages lacking safe drinking water sources, while 81 new water sources were constructed (boreholes, wells and dikes), 55% in 1992-1993. The success of GWEP is attributed mainly to: intensive and simultaneous implementation of interventions in highly endemic villages in the first 3 years of the programme, case containment, and cash reward.

CONCLUSIONS

Cameroon is on the threshold of eliminating dracunculiasis from Mayo Sava but the major remaining obstacle is the ever increasing threat of re-infestation from neighbouring countries.

A retrospective six-months clinical trial of adhesive precoated brackets and bonding system

This study investigated bond failures in two groups of 75 patients. Either adhesive precoated (APC) or control brackets were bonded from bicuspid to bicuspid in the mandibular and maxillary arch by a single experienced operator. Observations on failure were recorded at initial arch wire insertion and for the first six months of treatment. The APC bracket failed significantly more often than the control at initial arch wire insertion in both maxillary and mandibular teeth. Further examination disclosed that the APC bracket, when bonded to mandibular teeth, also failed significantly more often than the control during the subsequent six months of treatment. At the six-month point of the study, a total of 53 bond failures had occurred at 671 bond sites in the APC group (7.89 per cent failure rate), compared to 27 bond failures at 977 bond sites in the control group (2.76 per cent failure rate). Fourteen patients in the APC group and two patients in the control group experienced bond failure at initial arch wire insertion. Twenty-eight patients in the APC group and 13 in the control group experienced bond failures within the first six months following initial arch wire insertion.

Cameroon: an African model for final stages of guinea worm eradication

The Cameroon Guinea worm eradication program initiated case containment activities in 1991 in the Mayo-Sava Division, the only endemic region in the country. These activities differed from the Pakistan program, the only other operational model for dracunculiasis case containment, in two important ways. In Cameroon, next-level supervisors received reports of new cases from village health workers during routine weekly visits to endemic villages. The Pakistan program established a faster case reporting scheme that allowed higher level personnel (sector supervisors and regional managers) to confirm cases within one week of worm emergence. Second, in Cameroon case containment activities were extended only to villages reporting five or more cases the previous transmission season and villages with recent confirmed cases. In Pakistan, all villages reporting cases during the previous year were included in the program. A village-by-village case search one year after initiation of case containment in the Mayo-Sava indicated decreases of 60% in the number of cases and 51% in the number of villages reporting cases. Based on the apparent success of the efforts in Cameroon, we propose a two-stage scheme for implementation of case containment. Both stages are based on rapid detection and containment of cases, within 24 hr of worm emergence, by village-based health workers. In stage 1, cases are reported and confirmed during routine weekly visits to the endemic villages by next-level supervisors. Weekly reporting should be extended to all villages with recent confirmed cases and to as many villages reporting cases during the previous transmission season as logistically possible.(ABSTRACT TRUNCATED AT 250 WORDS)