The Practices of Anaesthesiologists in the Management of Patients with Sickle Cell Disease: Empirical Evidence from Cameroon

Patients with sickle cell disease are more likely to undergo surgery during their lifetime, especially given the numerous complications they may develop. There is a paucity of data concerning the management of patients with sickle cell disease by anaesthesiologists, especially in Africa. This study aimed to describe the practices of anaesthesiologists in Cameroon concerning the perioperative management of patients with sickle cell disease. A cross-sectional study was carried out over four months and involved 35 out 47 anaesthesiologists working in hospitals across the country, who were invited to fill a data collection form after giving their informed consent. The data were analysed using descriptive statistics and a binary logistic regression model. Among the 35 anaesthesiologists included in the study, most (29 (82.9%)) had managed patients with sickle cell disease for both emergency and elective surgical procedures. Most of them had never asked for a haematology consultation before surgery. Most participants (26 (74.3%)) admitted to having carried out simple blood transfusions, while 4 (11.4%) carried out exchange transfusions. The haemoglobin thresholds for transfusion varied from one practitioner to another, between <6 g/dL and <9 g/dL. Only 6 (17.1%) anaesthesiologists had a treatment guideline for the management of patients with sickle cell disease in the hospitals where they practiced. Only 9 (25.7%) prescribed a search for irregular agglutinins. The percentage of haemoglobin S before surgery was always available for 5 (14.3%) of the participants. The coefficient (0.06) of the occurrence of a haematology consultation before surgery had a significant influence on the probability of management of post-operative complications (coefficient 0.06, 10% level of probability). This study highlights the fact that practices in the perioperative management of patients with sickle cell disease in Cameroon vary greatly from one anaesthesiologist to another. We disclosed major differences in the current recommendations, which support the fact that even in Sub-Saharan countries, guidelines applicable to the local settings should be published

Anesthésie du patient drépanocytaire dans un environnement à ressources limitées: expérience au Cameroun

IntroductionLa drépanocytose est la pathologie génétique la plus fréquente au monde touchant plus de 50 millions de personnes dont 38 millions en Afrique subsaharienne. C’est une maladie chronique génétique à transmission autosomique récessive liée à une anomalie structurale et qualitative de l’hémoglobine. Au Cameroun, 4000 enfants naissent drépanocytaires chaque année. Toutes les tranches d’âges sont touchées et les jeunes de 10 à 29 ans représentent 89,2% des malades. L’espérance de vie pour un drépanocytaire est de 25 ans. Ces patients sont plus susceptibles de subir une intervention chirurgicale au cours de leur vie que la population générale en raison de la nature des complications de cette maladie. La procédure anesthésique nécessite plusieurs impératifs notamment la prévention de tous les facteurs de risque de falciformation afin de limiter les risques de complication postopératoire. Le patient drépanocytaire peut également présenter différentes réponses pharmacologiques aux anesthésiques en l’occurrence aux curares, dues à plusieurs altérations pathologiques, y compris les anomalies de la microcirculation, l’anémie chronique, ou une insuffisance rénale progressive.MéthodologieDes études de type transversal descriptif (enquêtes à l’aide de questionnaire) et de type prospectif descriptif et observationnel (comparaison à un groupe témoin) ont été réalisées. Nos travaux se sont déroulés au Cameroun et pour la plupart du temps dans les villes de Douala et Yaoundé mais aussi dans les principales villes des huit autres régions du pays. Les blocs opératoires de quelques hôpitaux de référence des différentes villes ont servi de lieu de collecte de la plupart de nos données :conduite de l’anesthésie avec monitorage de la curarisation, surveillance postopératoire, identification des complications postopératoires et recherche des facteurs favorisants lesdites complications.RésultatsL’enquête a montré que sur 35 médecins anesthésistes inclus dans l'étude, 29 (82,9 %) avaient pris en charge des malades pour des procédures chirurgicales d'urgence et électives. La plupart d'entre eux 27 (77,1%) n'avaient jamais demandé de consultation d'hématologie avant une intervention chirurgicale. Seuls 6 (17,1%) anesthésistes disposaient d'un protocole rédigé pour la prise en charge préopératoire des drépanocytaires dans les hôpitaux où ils exerçaient. Au total, 124 patients atteints de drépanocytose ont été recrutés de manière prospective ;64 étaient des hommes et 60 des femmes, soit un sex-ratio de 0,93. Le taux de complications postopératoires était de 23,4 % (29/124) et le taux de décès de 3,2 % (4/124). Les sujets féminins ont eu plus de complications que les sujets masculins p < 0,05. Le nombre de crises vaso-occlusives subies par an, a montré un impact significatif sur la survenue des complications postopératoires p < 0,05. La chirurgie laparoscopique a eu moins de complications postopératoires 5/46 (10,9%) que la laparotomie 14/43 (32,5%). La technique chirurgicale pour les procédures abdominales a eu un impact significatif sur la survenue de complications post-opératoires p < 0,05. Le type de chirurgie (p = 0,198) et la technique d'anesthésie (p = 0,225) n'ont pas montré d'impact significatif sur la survenue de complications postopératoires.Le délai d'action du rocuronium était plus long chez les patients drépanocytaires [moyenne ± écart-type (minimum-maximum)], [6,3±2,1 (1,8-10) min] que dans le groupe témoin [2,5±0,6 (1,4-3,5) min] (P < 0,01). La durée d’action clinique était plus courte chez les patients drépanocytaires [19,2±7,1 (13-41) min] par rapport au groupe témoin [28,9±6,9 (21-48) min] (P < 0,01). Le délai avant la première réinjection était plus court dans le groupe de patients drépanocytaires [27,7±7,9 (19-49) min] que dans le groupe témoin [39,9±8,7 (30-56) min] (P < 0,01).ConclusionL’anesthésie du patient drépanocytaire au Cameroun fait face à des challenges tels que le nombre réduit de médecins anesthésistes, la non harmonisation des pratiques et la faible implication des hématologues et autres spécialistes de cette maladie dans la préparation de ces patients à la chirurgie. Bien que les pratiques courantes sont différentes de celles des milieux à ressources élevées, l'incidence des complications postopératoires et les complications rencontrées ne sont pas significativement différentes. Une susceptibilité aux complications postopératoires y est particulièrement notée chez les femmes drépanocytaires ainsi que chez ceux présentant plus fréquemment des crises vaso-occlusives. L’utilisation du monitorage de la curarisation dès l’induction anesthésique a permis de constater un délai d’action plus long du rocuronium chez ces patients comparé à celui observé dans la population générale. L’enseignement, l’éducation et des protocoles facilement applicables dans ce contexte spécifique, associant entre autres une meilleure prise en charge de la drépanocytose en dehors des phases aiguës, le choix de la laparoscopie dans la mesure du possible lors des chirurgies abdominales et l’utilisation systématique du monitorage du bloc neuromusculaire lors de l’usage des curares permettraient d’améliorer la morbidité et la mortalité postopératoires chez les patients drépanocytaires.Doctorat en Sciences médicales (Médecine)info:eu-repo/semantics/nonPublishe

The practices of anaesthesiologists in the management of patients with sickle cell disease: Empirical evidence from cameroon

Patients with sickle cell disease are more likely to undergo surgery during their lifetime, especially given the numerous complications they may develop. There is a paucity of data concerning the management of patients with sickle cell disease by anaesthesiologists, especially in Africa. This study aimed to describe the practices of anaesthesiologists in Cameroon concerning the perioperative management of patients with sickle cell disease. A cross-sectional study was carried out over four months and involved 35 out 47 anaesthesiologists working in hospitals across the country, who were invited to fill a data collection form after giving their informed consent. The data were analysed using descriptive statistics and a binary logistic regression model. Among the 35 anaesthesiologists included in the study, most (29 (82.9%)) had managed patients with sickle cell disease for both emergency and elective surgical procedures. Most of them had never asked for a haematology consultation before surgery. Most participants (26 (74.3%)) admitted to having carried out simple blood transfusions, while 4 (11.4%) carried out exchange transfusions. The haemoglobin thresholds for transfusion varied from one practitioner to another, between <6 g/dL and <9 g/dL. Only 6 (17.1%) anaesthesiologists had a treatment guideline for the management of patients with sickle cell disease in the hospitals where they practiced. Only 9 (25.7%) prescribed a search for irregular agglutinins. The percentage of haemoglobin S before surgery was always available for 5 (14.3%) of the participants. The coefficient (0.06) of the occurrence of a haematology consultation before surgery had a significant influence on the probability of management of post-operative complications (coefficient 0.06, 10% level of probability). This study highlights the fact that practices in the perioperative management of patients with sickle cell disease in Cameroon vary greatly from one anaesthesiologist to another. We disclosed major differences in the current recommendations, which support the fact that even in Sub-Saharan countries, guidelines applicable to the local settings should be published.SCOPUS: ar.jDecretOANoAutActifinfo:eu-repo/semantics/publishe

Légionellose compliquée d’une rhabdomyolyse et d’une insuffisance rénale aiguë: À propos d’un cas

Legionnaires’ disease is a bacterial disease of the respiratory system caused by a gram-negative germ whose clinical manifestation can be benign limiting to flu-like syndrome or can be more severe being characterized by pneumonia which may be complicated by multisystem disease that can lead to death. We report the case of a 48 year-old patient with rhabdomyolysis complicated by acute renal failure following Legionella pneumophila pneumonia. We here highlight the pathophysiological aspects and treatment of this rare complication during Legionella infection.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Incidence of Post-Operative Complications and Factors Influencing Their Occurrence in Patients with Sickle Cell Disease in a Low-Income Country: A Case Study of Cameroon

This study aimed to analyse post-operative complications and possible factors influencing their occurrence in the management of patients with sickle cell disease in a low-income country. We prospectively collected data regarding the management of patients with sickle cell disease requiring anesthesia for surgery in 11 Cameroonian hospitals from 1 May 2019 to 30 April 2021. The data were analysed using descriptive statistics and a binary logistic regression was used to determine the dependence between the variables. A total of 124 patients with sickle cell disease were enrolled; 64 were male and 60 female, giving a sex ratio of 0.93. The rate of post-operative complications was 23.4% (29/124) and the death rate was 3.2% (4/124). The female subjects had more complications than the male subjects p < 0.05. The number of vaso-occlusive crises experienced per year showed a significant impact on the occurrence of post-operative complications p < 0.05. Laparoscopic surgery had fewer post-operative complications 5/46 (10.9%) than laparotomy 14/43 (32.5%). The surgical technique for the abdominal procedures had a significant impact on the occurrence of post-operative complications p < 0.05. The type of surgery (p = 0.198) and the anaesthesia technique (p = 0.225) did not show a significant impact on the occurrence of post-operative complications. Particular attention should be paid to female patients with sickle cell disease as they are more likely to experience postoperative complications, as well as to the frequency of vaso-occlusive crises, which are also predictive of post-operative complications. Opting for laparoscopic surgery whenever possible would help to reduce post-operative complications.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Blunt abdominal trauma with duodenal dissection: A case report

We describe a new case of duodenal wound with complete transection in a 22-year-old patient following a motorcycle accident. He presented to the emergency room of the rural Regional Hospital of Ed&eacute;a in Cameroon with a clinical picture of acute abdomen and post-trauma hemodynamic instability. A peritoneal puncture brought back an incoagulable blood. An exploratory laparotomy revealed a large hemoperitoneum mixed with food debris. A tear of the omentum and transverse mesocolon and a complete section of the third duodenum at the beginning of its free portion were observed. The surgeon performed emergency closure of both duodenal stumps and performed an isoperistaltic lateral gastrojejunal bypass. A transfer to a specialized center for a more anatomical continuity was considered, but the imminence of a humanitarian mission in the hospital prompted the surgeon to seize the opportunity of this mission for the reoperation. This surgical revision was performed on the fifth postoperative day. A resection of the distal duodenal stump and the adjacent jejunal segment including the anastomosis was performed. Continuity was restored by a mechanical duodenal-jejunal anastomosis. The patient was discharged on the 18th postoperative day. This type of lesion is difficult to manage in an emergency situation in a structure with limited technical resources. Unfortunately, surgeons treating polytraumatized civilians are encountering an increasing number of blunt duodenal wounds requiring laborious management

Épilepsie et natation en piscine privée dans les pays en voie de développement, une pratique à haut risque vital : une observation clinique: Epilepsy and swimming in private pool in developing countries, a high risk life practice: a case report

Epilepsy is a chronic disease of the brain that affects all segments of the population around the world. It is characterized by recurrent seizures manifested by brief episodes of involuntary tremors affecting one part of the body or the whole body. These seizures are the result of excessive electrical discharges from a neuronal population. According to the World Health Organization, 50 million people are currently living with epilepsy worldwide. Almost 80 % of people with epilepsy live in low-income countries The management of this pathology remains difficult in sub-Saharan Africa for various reasons Sports activities, including swimming, are said to be beneficial in children and adolescents with epilepsy. But the practice of these activities is not without vital risk, it must be regulated accordingto the socio-economic, cultural and medical environment We report here a case of drowning in a 10-year-old adolescent girl, epileptic since earlychildhood and who takes depakine as a background treatment She was drowned while&nbsp; swimming in a private pool, following an epileptic seizure. The interest of this presentation is tounderline the need to formulate recommendations adapted to sub-Saharan Africa concerning the practice of certain sports activities, such as swimming in a private pool for adolescents with epilepsy. The second objective is to highlight the importance of the chain of survival in the event of drowning, as a guarantee of the vital prognosis. L’épilepsie est une affection chronique du cerveau qui touche toutes les tranches de la population dans le monde Selon l’organisation mondiale de la santé, 50 millions de personnes vivent actuellement avec l’épilepsie dans le monde, près de 80% de personnes souffrant d’épilepsie vivent dans les pays à revenu faible. Sa prise en charge demeure laborieuse en Afrique subsaharienne (ASS). Les activités sportives, parmi lesquelles la natation, seraient&nbsp; bénéfiques chez les adolescents épileptiques. Mais la pratique de ces activités n’est pas dénuée de risque vital, elle doit être régulée en fonction du contexte socio-economique, culturel et de l’environnement médical. Nous rapportons un cas de noyade chez une adolescente, épileptique depuis la tendre enfance et qui prend la dépakine en traitement de fond Elle a été victime de noyade en piscine privée, à la suite d’une crise d’épilepsie L’intérêt de cette présentation est de souligner la nécessité de formuler des recommandations adaptées à l’ASS au sujet de la pratique de certaines activités sportives à risque, comme la natation en piscine privée pour les adolescents épileptiques Le second objectif est de relever l’importance de la chaine de survie en cas de noyade, comme gage du pronostic vital

Prospective, randomized clinical trial of laparoscopic totally extraperitoneal inguinal hernia repair using conventional versus custom-made (mosquito) mesh performed in Cameroon: a short-term outcomes.

Adverse economic conditions often prevent the widespread implementation of modern surgical techniques in third world countries such as in Sub-Sahara Africa.info:eu-repo/semantics/publishe

A Novel 8-Predictors Signature to Predict Complicated Disease Course in Pediatric-onset Crohn’s Disease: A Population-based Study

International audienceBackground The identification of patients at high risk of a disabling disease course would be invaluable in guiding initial therapy in Crohn’s disease (CD). Our objective was to evaluate a combination of clinical, serological, and genetic factors to predict complicated disease course in pediatric-onset CD. Methods Data for pediatric-onset CD patients, diagnosed before 17 years of age between 1988 and 2004 and followed more than 5 years, were extracted from the population-based EPIMAD registry. The main outcome was defined by the occurrence of complicated behavior (stricturing or penetrating) and/or intestinal resection within the 5 years following diagnosis. Lasso logistic regression models were used to build a predictive model based on clinical data at diagnosis, serological data (ASCA, pANCA, anti-OmpC, anti-Cbir1, anti-Fla2, anti-Flax), and 369 candidate single nucleotide polymorphisms. Results In total, 156 children with an inflammatory (B1) disease at diagnosis were included. Among them, 35% (n = 54) progressed to a complicated behavior or an intestinal resection within the 5 years following diagnosis. The best predictive model (PREDICT-EPIMAD) included the location at diagnosis, pANCA, and 6 single nucleotide polymorphisms. This model showed good discrimination and good calibration, with an area under the curve of 0.80 after correction for optimism bias (sensitivity, 79%, specificity, 74%, positive predictive value, 61%, negative predictive value, 87%). Decision curve analysis confirmed the clinical utility of the model. Conclusions A combination of clinical, serotypic, and genotypic variables can predict disease progression in this population-based pediatric-onset CD cohort. Independent validation is needed before it can be used in clinical practice