Therapeutic follow-up of postoperative patients on tramadol in the intensive care unit a tertiary African hospital: a cohort study

Background: Tramadol, an analgesic, is a prodrug requiring bioactivation through cytochrome P450 enzymes (CYP450) to obtain O-desmethyltramadol (M1), its active metabolite. However, little is known on the African pharmacogenetic profile of tramadol metabolism. Hence, we aimed to study the biological efficacy of tramadol in an African population.Methods: This was a prospective cohort study over a 3-month period carried out at intensive care unit of a Cameroonian tertiary hospital. We enrolled patients with moderate-to-severe pain surgery, who had not been administered drugs metabolized by CYP450. Immediately after surgery, 2 mg/kg of tramadol was administered intravenously every 6 hours. Pain was assessed using the visual analog scale (VAS) within the first 24 hours. Vital signs and side effects were recorded. Plasma samples were collected at 3rd and 6th hours to assay tramadol and M1 using HPLC-UV.Results: We enrolled 30 patients with a mean age of 32 years operated for caesarean section, laparotomy and cancer surgery, under spinal and general anesthesia. Before administration of tramadol, the VAS was 6/10. The VAS decreased 4/10 to 1/10 between the 3rdand the 6th hour. There was a reduction of the respiratory rate of 3 breath cycles per minute as early as the 6th hour. Samples from 13 patients were analyzed. M1 was found in all patients; of which 4 had a slow metabolism and 3 had a faster metabolism.Conclusions: Overall there was good correlation between the clinical and biological analgesic efficacy of tramadol

Severe Viperidae envenomation complicated by a state of shock, acute kidney injury, and gangrene presenting late at the emergency department: a case report

Abstract Background Snake envenomation is an underestimated pathology in sub-Saharan Africa associated with severe emergencies, and even death in case of late presentation. We herein present a case of severe envenomation managed at the surgical emergency department of the Yaoundé Central Hospital. Case presentation We report a case of a 47-year-old female farmer with no relevant past history who sustained a snakebite by an Echis occellatus viper during an agricultural activity. Her initial management consisted in visiting a traditional healer who administered her some herbal remedies orally and applied a white balm on the affected limb. Due to progressive deterioration of her condition, she was rushed to our surgical department where she arrived 20 h after the snakebite incident. On admission she presented in a state of shock (suggestive of an anaphylactic shock), coagulopathy, renal impairment, and gangrene of the entire right upper limb. Emergency management consisted of fluid resuscitation, repeated boluses of adrenaline, a total of three vials of polyvalent anti-venom sera, promethazine, analgesics, corticosteroids, and administration of fresh frozen plasma. Within four hours of emergency department hospitalisation she developped signs of sepsis and persistent hypotension refractory to fluid resuscitation, suggestive of an associated septic shock. Management pursued with antiobiotherapy and administration of noradrenaline through an electric pump syringe to achieve a mean arterial blood pressure above 65 mmHg. The patient deceased at the 10th hour of hospitalisation in a state of circulatory collapse unresponsive to vasopressors, coagulopathy, renal failure, sepsis and gangrene of the right forearm. Conclusion The authors highlight this unusual presentation but equally pinpoint how late presentation to the emergency department, harmful tradition practices, poverty and cultural beliefs can adversely affect the prognosis of snakebite in our setting

Urgences neurologiques au service de réanimation de l’Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé : aspects clinique, étiologique, thérapeutique et pronostique

Objectif: Le but de notre étude était de déterminer la proportion et les étiologies des urgences neurologiques, de décrire leur prise en charge et d’évaluer leur pronostic dans une unité de réanimation.Méthodologie: Il s’agissait d’une étude cohorte prospective de 6 mois. Etaient inclus tous les patients de sexe féminin et d’âge supérieur ou égal à 18 ans, admis pour une urgence neurologique dans l’unité de réanimation de l’Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé. Etaient exclues de l’étude les patientes ayant refusé de participer à l’étude, celles présentant une notion de traumatisme, les décès précoces (< 24 heures après l’admission). Les informations collectées concernaient les données cliniques, thérapeutiques, la durée de séjour et le devenir des patients. La comparaison des pourcentages entre les variables était faite avec le test de Khi carré, avec comme seuil de significativité p < 0,05.Résultats: Au total, 37 cas d’urgences neurologiques étaient enregistrés sur 499 patients admis soit une prévalence de 7,41% et seuls 35 patientes étaient inclus. L’âge moyen était de 38,2 ± 22,1 ans. Le délai moyen d’admission était de 16 heures. Les principaux antécédents étaient : la période post-partum (n=10, 27%), l’aménorrhée gravidique (n=7, 18,9%). Tous les patients présentaient une céphalée, une convulsion, un déficit neurologique focal et un syndrome méningé. Les principales étiologies étaient : l’éclampsie (n=17, 48,6%), les comas non traumatiques (n=8, 22,9%), les accidents vasculaires cérébraux (n=5, 14,3%), les méningo-encéphalites (n=5, 14,3%). Pour une durée moyenne de séjour de 6,5 ± 5,9 jours, la mortalité globale était de 37,1%, soit 13 décès. Les causes les plus fréquentes dans de décès étaient les méningo-encéphalites (n=4, 30,7%), le choc septique (n=3, 23,1%) et l’AVC (n=3, 23,1%). Les facteurs associés au décès étaient l’âge > 55 ans, l’infection au VIH, le score de Glasgow < 8, le délai d’admission > 6 heures, la mauvaise observance du traitement et la survenue de complications (p < 0,05).Conclusion: Près d’un patient sur 10 admis en réanimation présente une urgence neurologique. Un patient sur 3 avec urgence neurologique décédera. La prévention de l’éclampsie et la consultation à temps pourraient conduire à réduire cette mortalité.Mots clés: Urgence neurologique, Prise en charge, Réanimation, Pronostic, YaoundéEnglish Title: Neurological emergencies in the intensive care unit of the Yaounde Gynaeco- Obstetric and Paediatric Hospital: clinical presentation, treatment and outcomeEnglish AbstractObjective: The aim of our study was to describe the clinical, etiological, therapeutical and prognostical aspects of neurological emergencies in the intensive care unit.Materials and methods: We carried out a prospective cohort study over 6 months. We included female adult patients admitted for neurological emergencies into the intensive care unit of the Yaoundé Gynaeco- Obstetric and Pediatric Hospital. We studied the prevalence of neurological emergencies, the different emergencies encountered, treatment administered, and outcome.Results: The frequency of neurological emergencies was 7.4%. Eclampsia was recorded in 48.6% of patients. The management of eclampsia was based on the use of magnesium sulphate and antihypertensive bitherapy with nicardipine and alpha methyl-DOPA. All cases of neurological infection received empirical triple antibiotic therapy with short duration corticosteroid therapy. Management of non traumatic coma was mainly symptomatic. Management of strokes was oriented by the findings on the head CT scan. Non traumatic coma and neurological infections were the most deadly, responsible for 46.2% and 30.7% of deaths respectively. Factors associated to poor prognosis were age greater than 55 years, HIV immune deficiency, a Glasgow score less than or equal to 8, admission interval greater than 6 hours, poor adherence to treatment, and the development of complications.Conclusion: The management of neurological emergencies is not optimal. We can ameliorate our management by efficient health policies.Keywords: Neurological emergencies, Management, Intensive care unit, Prognosis, Yaound