Video-laryngoscopy introduction in a Sub-Saharan national teaching hospital: luxury or necessity?

Tracheal intubation using Macintosh blade is the technique of choice for the liberation of airways. It can turn out to be difficult, causing severe complications which can entail the prognosis for survival or the adjournment of the surgical operation. The video-laryngoscope allows a better display of the larynx and a good exposure of the glottis and then making tracheal intubation simpler compared with a conventional laryngoscope. It is little spread in sub-Saharan Africa and more particularly in Burkina Faso because of its high cost. We report our first experiences of use of the video-laryngoscope through two cases of difficult tracheal intubation which had required the adjournment of the interventions. It results that the video-laryngoscope makes tracheal intubation easier even in it's the first use because of the good glottal display which it gives and because its allows apprenticeship easy. Therefore, it is not a luxury to have it in our therapeutic arsenal.Pan African Medical Journal 2015; 2

Détresse vitale du nouveau-né en salle de naissance au CHU-YO de Ouagadougou: intérêt de la réanimation néo natale

Introduction: La détresse vitale extra-utérine n'est souvent pas anticipée dans les pays en développement aggravant ainsi la mortalité néonatale. L'objectif de notre étude était de rapporté l'incidence des détresses, de décrire les aspects de la prise en charge et l'évolution à court terme. Méthodes: Nous avons mené une étude transversale descriptive dans le service de gynéco-obstétrique du CHU-YO de Ouagadougou du 15 avril au 15 juin 2015. Les nouveaux nés avec un score d'Apgar inférieur à 6 à la première minute ont été inclus. Les caractéristiques  sociodémographiques des mères, les étiologies ont été décrites. Les gestes vitaux, les médicaments utilisés ainsi que l'évolution ont été notés. Le plateau technique et la qualification des soignants ont été rapportés. Résultats: Quatre-vingt-trois nouveaux nés sur 1266 naissances vivantes ont présenté une détresse vitale, soient 6,55%. La moyenne d'âge des mères était de 25,48 ans. La durée de l'accouchement à excéder 12 heures dans 41 cas (49,40%) et dans 59 cas (71,10%) les mères ont accouché par césarienne. Tout le personnel (100%) en charge des nouveaux nés était des sages-femmes. L'aspiration à la poire a été réalisée dans 69 cas (soit 83,1%). Le massage cardiaque a été effectué chez 16 nouveaux nés (soit 19,3%). Nous avons enregistré 19 décès (22 ,90%). Conclusion: La fréquence des détresses à la naissance est élevée en salle de naissance à la maternité du CHU-YO. Le monitorage technique est insuffisant. La réanimation a abouti à 65 cas (soit 78,30%) de survie dans les dix premières minutes.Pan African Medical Journal 2016; 2

Réveil peropératoire et memorisation: prévalence et aspects cliniques dans un Pays Sub-Saharien

Objective: To study intraoperative memorization in the service of general surgery of Yalgado Ouedroago teaching Hospital (YO-TH) in Burkina Faso. Methods: It was a prospective study in the service of general surgery of YOTH over 7 months. The inclusion criteria were: age ≥ 18 years, absence of psychiatric disorder, American Society of Anesthesiology (ASA) score less than 4, informed consent written. Patients were interviewed at recovery. The questionnaire of Brice et al [8] was used and data were analyzed with SPHINX version 5.0.1 Results: A total of 475 patients were included. The mean age was 40.4 ± 16.3 years. The sex ratio was 1.4. The majority (56%) took psychoactive substance and 78.1% of patients had ASA score 2 or 3. Seven (1.4%) patients reported an explicit perioperative memorization (EPOM +). The mean age of EPOM + patients was 26.8 ± 6.57 years with a sex ratio 1.3. There was difference between EPOM + patients and EMPO - for age (p = 0.0001), occupation (p = 0.009) and antecedent of local anesthesia (p = 0.004). Five patients reported auditory perceptions, four cases of visual perceptions and two tactile perceptions. Pain was the most unpleasant memorization recorded. The psychological consequences of EPOM + were anxiety (2 cases). Conclusion: The frequency of EPOM is low in our context and the main cause was a slight anesthesia

Economic and psychological burden of scheduled surgery cancellation in a sub-Saharan country (Burkina Faso)

Background: Cancellation of scheduled surgery creates a financial burden for hospitals, caregivers and patients. Cancellation causes emotional stress, which impacts on outcomes. In poor countries where the adequacy of healthcare is limited, the ethical dilemma created by scheduled surgery cancellation is particularly important.Objective: To identify the incidence, cost and emotional impact of elective surgical cancellation in a teaching hospital in BurkinoFaso.Methods: A four month, prospective, observational study was undertaken in a teaching hospital (Yalgado Ouedraogo). All surgical patients were eligible. The causes of cancellation, financial cost and patients’ emotional response were assessed. The cost was estimated using a tool adapted for the economic cost of African job types.Results: During the study period, 1 088 cases were scheduled to undergo inpatient surgery. Of these, 239 cases (21.9%) were cancelled. Among the cancelled cases, 237 were cancelled during preparation in the surgical ward and two cases were cancelled in the operation room. A large number of the patients were housewives (n = 87). The highest cancellation rate (35.9%) was found in general surgery. Cancellation was judged avoidable in 214 cases (89.5%). The total cost of surgery cancellation to the hospital was US$19 147 (mean value US$ 80 per patient). Patients lost a mean of US$62.70, which represented 117.6$ 4 989 ). Cancellation caused a negative emotional reaction in 205 patients (85.7%) and ‘sadness’ was the most frequent (54.8%; n = 131). Cancellation resulted in 163 days of work lost.Conclusion: Based on income, the cost of day of surgery cancellation was high in Burkina Faso.Keywords: cost, emotional reaction, psychology, surgery cancellatio

Evaluation de l’état nutritionnel des patients adultes agressés admis en réanimation au Centre hospitalier universitaire Souro Sanou de Bobo-Dioulasso (CHUSS)

L’objectif de cette étude est d’évaluer l’état nutritionnel des « patients agressés » admis dans le service de réanimation polyvalente du CHUSS de Bobo-Dioulasso. L’étude prospective et descriptive a été conduite de juin à décembre 2012 Quarante-huit patients ont été inclus, leur âge moyen était de 37,7 ± 14,7 ans. Le traumatisme crânien grave a constitué la situation d’agression la plus fréquente (58,3 %). La durée moyenne du séjour a été de 13,5 ± 10,6 jours. A l’admission, le taux de dénutrition variait de 18,8 à 37,7 % en fonction des paramètres utilisés. La courbe du taux de variation de la circonférence brachiale présente une corrélation linéaire très forte avec la durée d’hospitalisation (p<0,001), celle de l’albumine a une signification statistique moins forte ; l’évolution du taux de lymphocytes n’était pas modélisable. Les circonférences brachiales moyennes à J4 et J7 étaient significativement plus basses chez les patients dénutris à l’admission que chez ceux qui ne l’étaient pas (p= 0,001). Pour ce qui est de l’albuminémie la différence était significative seulement à J4. Les patients agressés admis en réanimation sont fréquemment dénutris. Cet état s’aggrave rapidement et sévèrement pendant leur séjour hospitalier.Mots-clés : dénutrition, patients agressés, réanimation, Burkina Faso

Predictors of severe hypoxemia among COVID-19 patients in Burkina Faso (West Africa): Findings from hospital based cross-sectional study

Introduction: COVID-19 is one of the world’s major health crises. The objective of this study was to determine the predictive factors of severe hypoxemia in patients hospitalized in COVID-19 health facilities in Burkina Faso. Patients and method: This study was a hospital-based cross-sectional study. The data collected relate to the period of the first wave of the epidemic (March 9 to June 30, 2020). All patients hospitalized for COVID-19 in the requisitioned health facilities of Ouagadougou were included in this study. Predictors of severe hypoxemia were identified using a multivariate logistic regression model. Results: During the study period, 442 patients were included, representing 45.7% of the total number of positive patients in the entire country. The most common co-morbidities were diabetes (55; 12.4%) and arterial hypertension (97; 21.9%). Severe hypoxemia (SpO2 < 90%) was observed in 64 patients (14.5%). Age over 65 years (OR = 8.24; 95% CI: 2.83–24.01) and diabetes (OR = 2.43; 95% CI: 1.17–5.06) were the predictors for occurrence of severe hypoxemia in multivariate analysis. Conclusion: The predictive factors of COVID-19 are similar in African and Caucasian populations. The surveillance of COVID-19 in risk groups should be strengthened to reduce their morbidity and mortality