KINERJA PEGAWAI NEGERI SIPIL DALAM PELAYANAN PUBLIK SAAT PANDEMI COVID-19 DI KANTOR KECAMATAN TIKALA KOTA MANADO

This study aims to find out and examine in depth about the performance of civil servants in public services at the Tikala Sub-District Office during the Covid-19 pandemic. The method used in this research is descriptive qualitative research method. Sources of data used in this study are divided into two types, namely primary data and secondary data. The steps used in data analysis techniques are editing, data classification, then drawing conclusions. The results showed that the performance of civil servants at the Tikala sub-district office was not as expected, because the service during the pandemic was not the same as before the Covid-19 pandemic. Working from home during the Covid-19 pandemic did not go as expected, because the service activities at the Tikala District office were work that had to be completed at the office, not at home

Pengaruh Penggunaan Unit Saluran Air Bertangga dan Saringan Pasir Cepat terhadap Penurunan Kadar Besi dalam Air

One of the reasons why the use of handpump wells is not popular in rural areas of Indonesia is that the smell and taste of iron. The iron content can be reduced through aeration by cascades and filtration. An experiment was carried out in the first week of November 1986. The water sample was taken from a handpump and the iron content varies from 0,950-2,850 mg/l. A significant reduction was obtained by letting the water cascade one time and there was further reduction with successive cascades. Aeration with one cascade continued with rapid sandfilter reduced the iron content to 0,160 mg/l or 91,06% of the original. The greatest reduction was obtained after 3 cascades and filtration

Les Occlusions Intestinales Par Nœud Ileo-Sigmoïdien : Aspects Diagnostiques, Thérapeutiques Et Pronostiques

Introduction: Ileosigmoid knot (ISK), also known as compound volvulus or double volvulus, is a rare disease and affects mostly male subjects in their fourth decade. Delayed diagnosis often leads to complications with a high incidence of digestive necrosis. Materials and methods: This was a 10-year retrospective, descriptive and analytical study from 1 January 2007 to 31 December 2016, which covered all patients operated emergently for ISK in the surgical and surgical specialty departments at the Niamey National Hospital (NNH). Results: The series involved 8 cases of ISK, representing 0.82% of intestinal obstructions. There were 7 men and 1 woman. The average age of patients was 44.33 years with extremes ranging from 25 to 60 years. The main clinical signs were: abdominal pain (100%), inability to pass gas and stool (100%), vomiting (87.5%) and abdominal meteorism (87.5%). Four patients (50%) had a clear obstructive syndrome and the other 4 patients (50%) had associated signs of peritoneal irritation. Paraclinical diagnosis was difficult because of atypical clinico-radiological signs, but in all cases an abdominal x-ray was performed and showed a double loop of dilated sigmoid shadow in 87.5% of the cases. Laparotomy was the first approach used in all patients and led to a 50% necrosis rate. Hartmann’s colectomy and ideal colectomy were used in identical proportions, with 50% each. Ideal colectomy was characterized by a morbidity rate of 50% and a mortality rate of 25% compared to 0% for Hartmann’s procedure. The overall morbidity was 25% and the overall mortality was 12.5%. The average hospital stay was 65.87 days (range 17 to 128 days). The average time before reestablishment of digestive continuity was 50.37 days (range 31-128 days). Conclusion: Ileosigmoid knot is a rare condition at Niamey national hospital where the diagnostic approach is similar to that of occlusions in general, but remains difficult due to its uncommonness and atypical clinico-radiological signs. Necrosis rates and postoperative complications remain high

Prise En Charge Des Victimes Du Conflit Armé Du Nord Mali Dans Les Hôpitaux De Niamey

Objectives: The aims of this study was to evaluate the management of lesions in victims of the malian conflict patients admitted to Niamey hospitals. Methods: A retrospective study was conducted in Niamey hospitals from January 1st, 2012 to December, 31th, 2013. Data collected included âge, sex, means of transport, topography of trauma, treatment and outcome. Results: The sample included fifty one (51) patients. All patients were male; the mean age was 29,5 years ± 9 years, ranging from 17-71 years. The age between 26 and 35 were most affected in 47% of cases (24 patients), soldiers represented 72.54% (37 patients); and civils 27.45% (14 patients). 74.50% of our patients (38) were been transported in Niamey by aircraft. The trauma concerned the members in 54.90% (28 cases), canio facial in 17.60% (9 cases), abdomen in 11.80% (6 cases). We observed only one polytrauma. 66.66% (34) of patients were injured by firearms, 29.41% (15) by accidents of roads, 3,93% by burn (2 patients). The lesions found were bone in 41.17% (21 patients), skin-muscle in 35.29% (18 patients), visceral in 9.80% (5 patients). Five patients died (9.80%). Conclusion: the internationalization of conflicts requires a reorganization of the care by involving all the nearness health structures in order to ensure adequate care and neutrality

Invagination Intestinale Aiguë De L’adulte: Aspects Diagnostiqsues, Thérapeutiques Et Étiologiques

Introduction: Acute intussusception is a rare clinical entity in adults where it accounts for only 1-2% of intestinal obstructions. The authors wanted to report cases of acute intussusception in adult patients, their diagnostic aspects, their management, and their etiologies. Patients and Methods: This study is a retrospective study of the medical files of patients of both sexes. They include adults over 15 years of age, operated between January 2010 and December 2014, who were diagnosed with obstruction due to acute intestinal intussusception. Results: Six cases of adult intestinal intussusception were collected. The average age was 26.5 years. The sex ratio was 1 and there were so many men as women. Five out of six patients were unstable on admission. The diagnosis was made preoperative in two cases out of six, 33.3%. Ultrasound revealed a target sign in two cases. The ileo-ileal form was the most frequent (5 cases out of 6) or 83.3%. Also, there were two cases of intestinal necrosis out of six. Intestinal resection was performed in five cases or 83.33%. The cause of intussusception was found in four cases out of six or 66.7%. Here, a tumor was the cause in half of the cases. Immediate surgical follow-up was uncomplicated in all patients. Conclusion: Acute intestinal intussusception of the adult is a very rare condition. The preoperative diagnosis of acute intussusception of the adult remains delicate. The ileo-ileal form is more frequent than the ileo-colic form in adults. Treatment is always surgical in adults

Prise En Charge Des Anévrismes Artériels Dans Un Centre Africain Non Spécialisée

Introduction: Arterial aneurysms affect 7 to 8% of people over 65 in the West and are the 2nd leading cause of death in these countries. In Africa this frequency is poorly evaluated. The objective of this work is to report the management of arterial aneurysms at the National Hospital of Niamey (HNN). Patients and methods: This was a retrospective, descriptive study over a period of eight (8) years from January 2009 to December 2016, performed in the surgical departments of the National Hospital of Niamey. Included in the study were patients of both sexes, hospitalized and / or operated for arterial aneurysm. Not included were patients treated for arterial aneurysm with incomplete records or those concerning the neurosurgical sphere. Results: During the study period, 17,748 patients were hospitalized in the general surgery departments, including 16 patients for arterial aneurysm, or 0.09% of surgical pathologies. There were 13 men (81.25%) and 3 women (18.75%), or a sex ratio of 4.33. The average age was 55.75 years with extremes ranging from 25 years old to 90 years old. The circumstances of discovery of the aneurysms were swelling of the antero-internal aspect of the thigh in 7 cases (43.75%), abdominal mass 6 cases (37.50%), then 2 cases (12.50%) of chest pain and incidental discovery in 1cas (6.25%). The most common risk factor was high blood pressure with 43.75% (7 cases). The aneurysm sat on the femoral artery in 43.75% (n = 7), of which 6 on the deep femoral and 1 on the superficial femoral, on the infrarenal aorta in 31.25% (n = 5), on thoracic aorta 12.50% (n = 2), on the iliac artery 12.50% (n = 2). For the diagnosis the angioscanner is realized in all the patients and in addition Doppler ultrasound in 43, 75% of cases. Twelve (12) patients benefited from curative surgical intervention by prosthetic graft by PTFE in 58.33% of cases and by Dacron in 41.66%. The average stay was 29.75 days and the immediate operative followup was complicated by thrombosis in 12.5% and parietal suppurations in 6.25%. We recorded two (2) deaths, ie 12.5% among non-operated patients. Conclusion: Arterial aneurysms are rare diseases at the HNN. Conventional surgery is the treatment performed in our patients. The postoperative course was simple in most cases

A beer a minute in Texas football: Heavy drinking and the heroizing of the antihero in Friday Night Lights

This article applies a qualitative framing analysis to the first three seasons of the television series Friday Night Lights, focusing particularly on its incorporation of heavy drinking into narrative representations of the player whose character is most consistently central to the game of football as fictionally mediated in small-town Texas over the course of those three seasons. The analysis suggests that over the course of that period Friday Night Lights embeds nuanced social meanings in its framing of alcohol use by that player and other characters so as to associate it with multiple potential outcomes. Yet among those outcomes, the most dominant framing works to, in effect, reverse a progression through which media representations historically evolved from a heroic model toward an antihero model, with heavy drinking central to that narrative process of meaning-making in such messages.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

Evaluation De L’efficacité De L’analgésie Postopératoire Procurée Par 100 μg De Morphine Versus 25 μg De Néostigmine Après Rachianesthésie Pour Fracture Du Fémur À Propos De 60 Cas

Les morphiniques par voie intrathécale renforcent l’analgésie peropératoire et participent à celle postopératoire. Des molécules comme la néostigmine ont été testées comme adjuvants aux anesthésiques locaux pour une meilleure analgésie postopératoire. La supériorité de la néostigmine par rapport à la morphine administrée par voie intrathécale n’a pas été prouvée. Nous proposons de comparer l’efficacité de l’analgésie postopératoire que procuraient 100 μg de morphine en intrathécale à celle de 25 μg de néostigmine au cours de rachianesthésie chez des patients proposés pour une chirurgie de fémur. L’objectif était de montrer que la gestion de la douleur postopératoire peut se faire par des adjuvants sans risque. Il s’agissait d’une étude prospective descriptive et analytique portant sur une période de trois mois allant du 1er septembre au 30 novembre 2019 à propos de soixante patients de sexe masculin randomisés en double aveugle repartis en deux groupes : Groupe M : Les patients ont reçu un mélange de 15 mg de bupivacaine 0,5% isobare + 25 μg de fentanyl + 100 μg de morphine. Groupe N : Les patients ont reçu un mélange de 15 mg de bupivacaine 0,5% isobare + 25 μg de fentanyl +25 μg de néostigmine. Les variables étudiées étaient les données démographiques, hémodynamiques, la douleur postopératoire, les effets indésirables (prurit, vomissement, dépression respiratoire) la qualité du bloc sensitif et moteur. L’analyse a été faite à l’aide du logiciel SPSS 10.0. Le test de Ki-2 a été utilisé pour comparer les variables qualitatives et le test t student pour celles quantitatives. Le seuil de signification était fixé à 5%. Durant la période d’étude un total de 401 actes chirurgicaux a été pratiqué dont 63,34 % sous anesthésie générale et 36,50 % sous rachianesthésie. L’étude portait sur soixante patients opérés sous rachianesthésie. L’âge moyen était de 30 ± 6 ans dans le groupe N et 32 ± 4 ans dans celui M. La classe ASA était comparable dans les deux groupes. L’hypertension artérielle était le principal antécédent (13, 3% pour le groupe N contre 20% pour celui M.). La durée moyenne de la chirurgie était de 90 ± 8 minutes. A la sortie du bloc opératoire le score EVA était nul chez tous les patients. A la première heure postopératoire le score EVA était de 08 ± 3 mm dans le groupe N versus 06 ±3 mm dans celui M (p = 0,852). A la quatrième heure postopératoire le score EVA était de 15,6 ± 20 mm dans le groupe N contre 3,3 ± 8 mm dans le M (p = 0,003). Mais à la huitième heure postopératoire dans le groupe N le score EVA était de 33,6 ± 33 mm contre 4 ± 9 mm ; la différence était statistiquement significative (p ˂ 0,001). Par contre dans le groupe M l’acmé de la douleur n’a été observée qu’à la 24ème heure. Dans le groupe N, le recours à un complément d’analgésie par la morphine intraveineuse pendant les 24 premières heures postopératoires était observé chez 16 patients (5,33%) alors qu’aucun complément d’analgésie n’a été jugée nécessaire dans le M. La différence était significative (p ˂ 0,001). La consommation moyenne de morphine intraveineuse dans le groupe N était de 2,6 ±1mg avec des extrêmes de 2 à 4 mg. Le délai moyen de la première demande d’analgésie supplémentaire était de 3 heures avec des extrêmes de 1 à 8 heures. Dans le groupe N, 56,7% des patients avaient présentés des nausées et vomissements contre 16,7% dans le groupe M, la différence était significative (p = 0,0001). Nous avions enregistrés 23,3% des cas de prurit dans le groupe N versus 33,3% dans celui M, la différence était non significative (P= 0,39). La néostigmine en intrathécale à la dose de 25 μg procurait une analgésie postopératoire moins efficace que celle de 100 μg de morphine en intrathécale. La néostigmine par voie intrathécale reste limitée du fait de la forte incidence des nausées vomissements. Intrathecal morphinics reinforce intraoperative analgesia and participate in postoperative analgesia. Other molecules, such as neostigmine, have been tested as adjuvants to local anesthetics for a better postoperative analgesia. The superiority of neostigmine over morphine administered intrathecally has not been proven. We propose to compare the effectiveness of postoperative analgesia provided by100 μg Intrathecal morphine to that of 25 μg of neostigmine during spinal anaesthesia in patients proposed for femur surgery. Show that the management of postoperative pain can be done with safe adjuvants. This was a prospective and analytical study over a three-month period from September 1 to November 30, 2019. There were sixty randomized double-blind male patients divided into two groups: Group M: received a mixture of 15 mg bupivacaine 0.5% isobaric acid + 25 μg fentanyl + 100 μg morphine. Group N: received a mixture of 15 mg bupivacaine 0.5% isobaric acid + 25 μg fentanyl + 25 μg neostigmine. The variables studied were demographic, hemodynamic, postoperative pain, adverse effects, quality of sensory and motor block. The analysis was done using the SPSS 10.0 software. The Ki-2 test was used to compare the qualitative variables and the student t test for the quantitative ones. The significance threshold was set at 5%. During the study period 401 patients were operated on. General anaesthesia was performed in 63.34% of cases and rachianesthesia in 36.50%. The mean age was 30 ± 6 years in the N group and 32 ± 4 years in the M. The ASA class was comparable in both groups. Arterial hypertension was the main antecedent (13.3% for the N group versus 20% for the M.). The average duration of the procedure was 90 ± 8 minutes. At the exit of the operating room the EVA score was nil in all patients. At the first postoperative hour the EVA score was 08 ± 3 mm in the N group versus 06 ± 3 mm in the M group (p = 0.852). At the fourth postoperative hour the EVA score was 15.6 ± 20 mm in the N group versus 3.3 ± 8 mm in the M (p = 0.003). But at the eighth postoperative hour in the N group the EVA score was 33.6 ± 33 mm versus 4 ± 9 mm; the difference was statistically significant (p ˂ 0.001). On the other hand, in group M, the acme of pain was observed only at the 24th hour. In group N, the use of supplemental intravenous morphine analgesia during the first 24 postoperative hours was observed in 16 patients (533%), whereas no additional analgesia was considered necessary in the M. The difference was significant (p ˂ 0.001). The average intravenous morphine consumption in the N group was 2.6 ± 1 mg with extremes of 2 to 4 mg. The average interval of the first request for additional analgesia was 3 hours with extremes of 1 to 8 hours. In group N, 56.7% of patients had nausea and vomiting compared to 16.7% in group M, the difference was significant (p = 0.0001). We recorded 23.3% of the pruritic cases in the N group versus 33.3% in the M group, the difference was not significant (P = 0.39). Intrathecal neostigmine at a dose of 25 μg provides less postoperative analgesia than intrathecal morphine 100 μg. Intrathecal neostigmine remains limited because of the high incidence of nausea and vomiting

Management of postoperative pain: experience of the Niamey National Hospital, Niger

Maman Sani Chaibou,1 Samuila Sanoussi,2 Rachid Sani,2 Nouhou A Toudou,1 Hadjara Daddy,1 Moussa Madougou,1 Idrissa Abdou,1 Habibou Abarchi,2 Martin Chobli31Department of Anesthesiology and Intensive Care, 2Department of Surgery, The Niamey National Hospital, Niamey, Republic of Niger; 3Department of Anesthesiology, Hubert K Maga University Teaching Hospital, Cotonou, BeninObjective: The aim of this study was to evaluate the management of postoperative pain at the Niamey National Hospital.Methods: A prospective study was conducted in the Department of Anesthesiology and Intensive Care at the Niamey National Hospital from March to June, 2009. Data collected included age, sex, literacy, American Society of Anesthesiologists (ASA) physical status classification, type of anesthesia, type of surgery, postoperative analgesics used, and the cost of analgesics. Three types of pain assessment scale were used depending on the patient's ability to describe his or her pain: the verbal rating scale (VRS), the numerical rating scale (NRS), or the visual analog scale (VAS). Patients were evaluated during the first 48 hours following surgery.Results: The sample included 553 patients. The VRS was used for the evaluation of 72% of patients, the NRS for 14.4%, and the VAS for 13.6%. Of the VRS group, 33.9%, 8.3%, and 2.1% rated their pain as 3 or 4 out of 4 at 12, 24, and 48 hours postoperatively, respectively. For the NRS group, 33.8%, 8.8%, and 2.5% rated their pain as greater than 7 out of 10 at 12, 24, and 48 hours postoperatively, respectively. For the VAS group, 29.3%, 5.4%, and 0% rated their pain as greater than 7 out of 10 at 12, 24, and 48 hours postoperatively, respectively. Conclusion: Postoperative pain assessment and management in developing countries has not been well described. Poverty, illiteracy, and inadequate training of physicians and other health personnel contribute to the underutilization of postoperative analgesia. Analysis of the results gathered at the Niamey National Hospital gives baseline data that can be the impetus to increase training in pain management and to establish standardized protocols.Keywords: postoperative pain, pain scales, Niamey National Hospita