Comparative analysis of primary repair vs resection and anastomosis, with laparostomy, in management of typhoid intestinal perforation: results of a rural hospital in northwestern Benin

BACKGROUND: The objective is to compare primary repair vs intestinal resection in cases of intestinal typhoid perforations. In addition, we hypothesised the usefulness of laparostomy for the early diagnosis and treatment of complications. METHODS: 111 patients with acute peritonitis underwent emergency laparotomy: number of perforations, distance of perforations from the ileocaecal valve, and type of surgery performed were recorded. A laparostomy was then created and explored every 48 to 72 hours. The patients were then divided into two groups according to the surgical technique adopted at the initial laparotomy: primary repair (Group A) or intestinal resection with anastomosis (Group B). Clinical data, intraoperative findings, complications and mortality were evaluated and compared for each group. RESULTS: In 104/111 patients we found intestinal perforations, multiple in 47.1% of patients. 75 had primary repair (Group A) and 26 had intestinal resection with anastomosis (Group B). Group B patients had more perforations than patients in Group A (p = 0.0001). At laparostomy revision, the incidence of anastomotic dehiscence was greater than that of primary repair dehiscence (p = 0.032). The incidence of new perforations was greater in Group B than in Group A (p = 0.01). Group B correlates with a higher morbility and with a higher number of laparostomy revisions than Group A (p = 0.005). There was no statistical difference in terms of mortality between Group A and Group B. Presence of pus in the abdominal cavity at initial laparotomy correlates with significantly higher mortality (p = 0.0001). CONCLUSIONS: Resection and anastomosis shows greater morbidity than primary repair. Laparostomy revision makes it possible to rapidly identify new perforations and anastomotic or primary repair dehiscences; although this approach may seem aggressive, the number of operations was greater in patients who had a favourable outcome, and does not correlate with mortality

Treatment of large diaphyseal bone defect of the tibia by the "fibula pro tibia" technique: Application in developing countries

Large segmental bone defects of the tibia may be due to infections, high-energy fractures, congenital diseases or tumors and represent a challenge for both the physician and the patient. In developing countries, the use of expansive techniques is not possible so that amputation is sometimes proposed. However, an alternative technique for limb salvage, applicable in developing countries consists of tibialization of the ipsilateral fibula. This technique is also called "Fibula pro Tibia", fibular transfer to the tibia or fibular centralization. We report this transfer in 4 patients with an average defect length of 11.8 cm. Union between the transferred fibula and the tibia was obtained in all patients, for both proximal and distal junctions, after an average time of 8.5 months (range, 4 to 18 months). Three patients returned to a normal walking function while one was still limping, but was able to walk independently without need of crutches

Surgical management of rickets-like bone deformities (knock-knee and bow-leg) in children in sub-Saharan Africa

Rickets-like deformities of the lower limb (knock-knee or bow-leg) are very frequent in sub-Saharan Africa. A prospective study was carried out over a period of 5 years. Forty-eight children were treated surgically for rickets-like deformities. The surgical technique was guided growth using a tension-band plate (eight plate). One patient was lost to follow-up. The technique failed in two cases (absence of correction in one case and hypercorrection in one case). Five patients are still under follow-up with progressive correction and were excluded from the study. A full correction was achieved in 40 patients (73 knees). There were 33 bilateral and 7 unilateral deformities. The deformities were knock-knees in 20 cases, bowlegs in 18 cases and there were 2 windswept deformities Good correction was obtained after a mean time of 11.4 months for genu varum and after a mean time of 12.4 months. The two windswept deformities were corrected after 8 and 9 months respectively. The guided growth technique using eight plate is effective as well in Africa. The needed material is not expensive if a two-hole tubular plate is used with two 3.5 screws

Effectiveness of the medicinal plant R019 in the treatment of HIV infection: An observational study

This study aims to evaluate the in vivo antiviral, immunologic, clinical effects and safety of a supposedly anti-HIV phytotherapy, code-named R019 used for the treatment of HIV/AIDS. This is an open observational study, which involved 32 HIV-1 infected patients, who were followed over a 3-month period. The efficacy evaluation was based on CD4 count, determination of viral load and clinical status. The safety evaluation was based on renal and liver function tests, fasting lipid and glycaemia levels as well as the frequency of other adverse events. The CD4 values increased significantly (mean±SD, 99.03±22.87 cells/μL; P<0.001), as well as Weight and Karnofsky score (2.94±0.67 kg, p<0.001; 4.9, p=0.005 respectively). The viral load decreased significantly (0.91±0.12 log viral load, P<0.0001). R019 did not impair renal or liver functions. Improvement of creatinine clearance was observed (p=0.02). Hemoglobin levels increased (0.38±0.16 gr/dL) whereas cholesterol and glucose levels decreased under R019 treatment (p=0.031, p=0.018 respectively). Main adverse effects were recorded: polyuria (40.5%), drowsiness (21.4%), orexis (19.1%). Immunological, anti-viral and clinical status improved under R019 treatment and a good safety profile was observed for this compound. Further studies would be required to optimize its efficacy and to define its appropriateness for the treatment of HIV disease

Management of severe knee extension stiffness in children : particularity in sub-Saharan Africa

Introduction: Knee extension stiffness due to fibrous retraction of the quadriceps is a relatively uncommon condition in children but not so rare in developing countries. It is the result of iatrogenic intra-muscular injection. It is responsible for major functional prejudices in the childPatients and methods: A retrospective study was carried out over a period of 4 years. Twenty children were treated surgically for knee extension stiffness. In 100% of cases it was a severe retraction of the knee. The quadriceps-plasty described by Judet was used in 16 cases and a V-Y quadriceps-plasty in 4 cases. Immediate post-operative physiotherapy was performed every 6 hours with positioning in splint (with every 6-hour alternation between extension and 100°-flexion splint).Results: The average knee flexion degree was 5° in preoperative period and improved to 103° after the surgery. The final result was considered excellent in 30% and good in 70% of the cases

Management of severe knee extension stiffness in children: Particularity in sub-Saharan Africa

Knee extension stiffness due to fibrous retraction of the quadriceps is a relatively uncommon condition in children but not so rare in developing countries. It is the result of iatrogenic intra-muscular injection. It is responsible for major functional prejudices in the child. A retrospective study was carried out over a period of 4 years. Twenty children were treated surgically for knee extension stiffness. In 100% of cases it was a severe retraction of the knee. The quadriceps-plasty described by Judet was used in 16 cases and a V-Y quadriceps-plasty in 4 cases. Immediate post-operative physiotherapy was performed every 6 hours with positioning in splint (with every 6-hour alternation between extension and 100°-flexion splint). The average knee flexion degree was 5° in preoperative period and improved to 103° after the surgery. The final result was considered excellent in 30% and good in 70% of the cases.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Management of severe knee extension stiffness in children: particularity in sub-Saharan Africa

Knee extension stiffness due to fibrous retraction of the quadriceps is a relatively uncommon condition in children but not so rare in developing countries. It is the result of iatrogenic intra-muscular injection. It is responsible for major functional prejudices in the child. A retrospective study was carried out over a period of 4 years. Twenty children were treated surgically for knee extension stiffness. In 100% of cases it was a severe retraction of the knee. The quadriceps-plasty described by Judet was used in 16 cases and a V-Y quadriceps-plasty in 4 cases. Immediate post-operative physiotherapy was performed every 6 hours with positioning in splint (with every 6-hour alternation between extension and 100°-flexion splint). The average knee flexion degree was 5° in preoperative period and improved to 103° after the surgery. The final result was considered excellent in 30% and good in 70% of the cases

Surveillance of surgical site infections. An emergency in Saint John of God Regional Hospital of Northem in Republic of Benin

Surveillance of surgical site infections: an emergency in Saint John of God regional hospital of Northern in Republic of BeninIntroduction: The patient’s endogenous source is mostly involved in the occurrence of surgical site infections1 (SSI). Exogenous contamination is less frequent. Objectives: - Determine the incidence of SSI in Caesarean parturient - Identify the causative germs. Methods: This is a prospective cohort study with real-time data collection, including Caesarean parturients from 01 February to 30 May 2014 and 2015. The follow-up with phone calls was provided up to +30 days. In case of suspicion of an SSI, samples for cytobacteriological examination of the liquid coming from the superficial or deep part of the incision have been realized. The data was entered and evaluated using Epi info6 software. Results: The incidence rate in 2014 is 16.72% (52/311) and 4.7% (14/ 300) in 2015. Third generation cephalosporins were used in 87.2% (472/541) for antibiotic prophylaxis. The SSI occurred after the exit of the parturients in 72.7% of the cases, 42 (63.6%) cases benefited cytobacteriological analysis from purulent secretions. The examination returned positive in 43% (18/42) of the cases, 57% (24/42) were decapitated (sampling after an average delay of antibiotic therapy of 6.9 ± 2.8 days). 20 germs were isolated, predominantly monomicrobial (88.9%), 65% were Gram-positive cocci: staphylococcus aureus accounted for 45% of the isolated germs including MRSA followed by Streptococcus agalactiae in 20%, no strain of staphylococcal coagulase has been found. Gram-negative bacilli represent 35%: 71.4% are enterobacteriaceae, 40% of which are extended-spectrum beta-lactamase (ESBL), Escherichia coli was isolated in 10%, the same for pseudomonas aeruginosa (without any resistance). Conclusion: The endogenous flora is responsible for the majority of documented SSI, whether through poor skin preparation or aseptic error, but the emergence of ESBL is linked to the use of broadspectrum antibiotics. This requires clinical, microbiological and therapeutic vigilance in view of their specific resistance profile to antibiotics