Encéphalopathie de Gayet-Wernicke compliquant des vomissements sur terrain de néoplasie colique

L'encéphalopathie de Gayet-Wernicke est une complication neuropsychiatrique aiguë secondaire à une carence en thiamine. Les vomissements incoercibles compliquant une obstruction intestinale chronique en sont une cause rare. Nous rapportons un cas d'encéphalopathie de Gayet-Wernicke compliquant des vomissements incoercibles sur terrain de néoplasie colique, chez une patiente de 60 ans

Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980�2015: a systematic analysis for the Global Burden of Disease Study 2015

Background Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time. Methods Drawing from analytical approaches developed and refined in previous iterations of the GBD study, we generated updated estimates of child mortality by age group (neonatal, post-neonatal, ages 1�4 years, and under 5) for 195 countries and territories and selected subnational geographies, from 1980�2015. We also estimated numbers and rates of stillbirths for these geographies and years. Gaussian process regression with data source adjustments for sampling and non-sampling bias was applied to synthesise input data for under-5 mortality for each geography. Age-specific mortality estimates were generated through a two-stage age�sex splitting process, and stillbirth estimates were produced with a mixed-effects model, which accounted for variable stillbirth definitions and data source-specific biases. For GBD 2015, we did a series of novel analyses to systematically quantify the drivers of trends in child mortality across geographies. First, we assessed observed and expected levels and annualised rates of decrease for under-5 mortality and stillbirths as they related to the Soci-demographic Index (SDI). Second, we examined the ratio of recorded and expected levels of child mortality, on the basis of SDI, across geographies, as well as differences in recorded and expected annualised rates of change for under-5 mortality. Third, we analysed levels and cause compositions of under-5 mortality, across time and geographies, as they related to rising SDI. Finally, we decomposed the changes in under-5 mortality to changes in SDI at the global level, as well as changes in leading causes of under-5 deaths for countries and territories. We documented each step of the GBD 2015 child mortality estimation process, as well as data sources, in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, 5·8 million (95 uncertainty interval UI 5·7�6·0) children younger than 5 years died in 2015, representing a 52·0% (95% UI 50·7�53·3) decrease in the number of under-5 deaths since 1990. Neonatal deaths and stillbirths fell at a slower pace since 1990, decreasing by 42·4% (41·3�43·6) to 2·6 million (2·6�2·7) neonatal deaths and 47·0% (35·1�57·0) to 2·1 million (1·8-2·5) stillbirths in 2015. Between 1990 and 2015, global under-5 mortality decreased at an annualised rate of decrease of 3·0% (2·6�3·3), falling short of the 4·4% annualised rate of decrease required to achieve MDG4. During this time, 58 countries met or exceeded the pace of progress required to meet MDG4. Between 2000, the year MDG4 was formally enacted, and 2015, 28 additional countries that did not achieve the 4·4% rate of decrease from 1990 met the MDG4 pace of decrease. However, absolute levels of under-5 mortality remained high in many countries, with 11 countries still recording rates exceeding 100 per 1000 livebirths in 2015. Marked decreases in under-5 deaths due to a number of communicable diseases, including lower respiratory infections, diarrhoeal diseases, measles, and malaria, accounted for much of the progress in lowering overall under-5 mortality in low-income countries. Compared with gains achieved for infectious diseases and nutritional deficiencies, the persisting toll of neonatal conditions and congenital anomalies on child survival became evident, especially in low-income and low-middle-income countries. We found sizeable heterogeneities in comparing observed and expected rates of under-5 mortality, as well as differences in observed and expected rates of change for under-5 mortality. At the global level, we recorded a divergence in observed and expected levels of under-5 mortality starting in 2000, with the observed trend falling much faster than what was expected based on SDI through 2015. Between 2000 and 2015, the world recorded 10·3 million fewer under-5 deaths than expected on the basis of improving SDI alone. Interpretation Gains in child survival have been large, widespread, and in many places in the world, faster than what was anticipated based on improving levels of development. Yet some countries, particularly in sub-Saharan Africa, still had high rates of under-5 mortality in 2015. Unless these countries are able to accelerate reductions in child deaths at an extraordinary pace, their achievement of proposed SDG targets is unlikely. Improving the evidence base on drivers that might hasten the pace of progress for child survival, ranging from cost-effective intervention packages to innovative financing mechanisms, is vital to charting the pathways for ultimately ending preventable child deaths by 2030. Funding Bill & Melinda Gates Foundation. © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license

Prescription des antibiotiqueschez les enfants de 0 a 14 ans au service depediatrie du Centre Medical Communal (CMC) de Ratoma

Introduction : L’administration sans délai d’un traitement antibiotique à un malade infecté peut décider de son destin. L’objectif de cette étude était d’évaluer la prescription des antibiotiques dans le service de pédiatrie du Centre Médical Communal de Ratoma.Méthodologie: Il a s’agissait d’une étude prospective, réalisée au service de pédiatrie du Centre Médical Communal de Ratoma sur 3 mois. Elle a inclue les enfants de 0 à 14 ans admis dans le service et pour lesquels au moins un antibiotique a été prescrit en consultation et en hospitalisation. La collecte a été faite au fur et à mesure des consultations d’enfants répondant aux critères de sélection. L’analyse et le traitement des données ont permis de générer des fréquences. Des consentements éclairés ont été obtenus auprès des parents.Résultats : Les antibiotiques ont été prescrit chez 72,08% d’enfants réçus. Les enfants de 0 à 4 ans en bénéficiaient le plus (72,1%).Les raisons de prescription les plus courantes étaient les infections respiratoires aiguës (58,46%). La classe la plus prescrite était celle des béta-lactamines (80,15%), particulièrement l’association amoxicilline + acide clavulanique (27,88%). Les formes sirop (59,2%) et comprimé (28,20%) étaient plus prescrit. La voie d’administration était souvent orale (87,4%). A l’issu de l’antibiothérapie, on notait 387 guérisons (99,23%), 1 décès (0,3%) et 2 perdu de vue(0,5%).Conclusion: La prescription des antibiotiques semble assez banale pour les affections respiratoires courantes à étiologies très variée. Ce comportement incite une mise à niveau par une formation des professionnels de santé. Mots clés: Prescription, Antibiotique, Enfants, Pédiatrie.   English Title: Prescription of antibiotics in children 0 to 14 years at the service of paediatrics at the CMC of Ratoma Introduction: Administration without delay of antibiotic treatment for an infected patient can decide its own fate. The objective of this study was to assess the prescription of antibiotics in paediatrics of the Centre Medical Commune de Ratoma Methodology: There was a study, prospective to the paediatric service of the Centre Medical Commune de Ratoma on 3 months. She includes children 0 to 14 years admitted and for which at least one antibiotic was prescribed in consultation and hospitalization. The collection was made as consultations of children meet the criteria of selection. Analysis and treatment of the data helped generate frequencies. Informed consent was obtained from the parent. Antibiotics have been prescribed in 72.08% of children received. Children from 0 to 4 years Results: benefited the most (72.1%). The most common reasons for prescription were acute respiratory infections (58,46%). The most prescribed class was that of the betalactam (80,15%), particularly the association amoxicillin + clavulanic (27.88%) acid. The syrup forms (59.2%) and compressed (28,20%) were most prescribed. The route of administration was often oral (87.4%). At the end of the antibiotic treatment, there were387 healings (99.23%), 1 death (0.3%) and 2 lost (0.5%). Conclusion: The prescription of antibiotics seems fairly common to common respiratory conditions to very varied etiologies. This behavior makes an upgrade by training of health professionals. Keywords: Prescription, Antibiotic, Children, Pediatri

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran

Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery

Background: Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatory drugs (NSAIDs) for reducing ileus after surgery. Methods: A prospective multicentre cohort study was delivered by an international, student- and trainee-led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre-specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. Results: A total of 4164 patients were included, with a median age of 68 (i.q.r. 57\u201375) years (54\ub79 per cent men). Some 1153 (27\ub77 per cent) received NSAIDs on postoperative days 1\u20133, of whom 1061 (92\ub70 per cent) received non-selective cyclo-oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4\ub76 versus 4\ub78 days; hazard ratio 1\ub704, 95 per cent c.i. 0\ub796 to 1\ub712; P = 0\ub7360). There were no significant differences in anastomotic leak rate (5\ub74 versus 4\ub76 per cent; P = 0\ub7349) or acute kidney injury (14\ub73 versus 13\ub78 per cent; P = 0\ub7666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35\ub73 versus 56\ub77 per cent; P < 0\ub7001). Conclusion: NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement