Aspects Epidemiologique, Diagnostique et Therapeutique des Urgences Urologiwues a l’Hopital Sounon Sero de Nikki au Benin

Les urgences urologiques regroupent un ensemble de pathologies multiples et variées. Elles sont plus fréquentes chez l’homme âgé à causes des affections prostatiques et restent dominées par la rétention aigue d’urine, les infections urogénitales et les grosses bourses. Elles peuvent différer d’un centre à l’autre sur le plan épidémiologique, mais également dans la prise en charge. OBJECTIF : Rapporter les aspects épidémiologique, diagnostique et d’évaluer la prise en charge des urgences urologiques dans l’hôpital SOUNON Séro de Nikki. PATIENTS ET METHODE : Il s’est agi d’une étude descriptive à collecte de données prospectives menée à l’hôpital SOUNON Séro de Nikki sur la période allant du 5 novembre 2020 au 5 mai 2021 soit 6 mois  et portait  sur 44 patients admis dans le service des urgences pour des urgences urologiques. Les variables étudiées étaient : l’âge, le sexe, la profession, le niveau d’instruction, le statut matrimonial, aspect clinique et thérapeutique. Les données ont été collectées sur une fiche individuelle de collecte, testée en amont, à partir des dossiers d’hospitalisation en respectant les considérations éthiques et de déontologie. Pour analyser les données, un logiciel SPSS version 2.0 nous a été utile et nous a permis d’obtenir nos résultats. RESULTATS : La tranche d’âge la plus représenté était celle de 60 – 74 ans avec 45,45% dont 100% hommes et la plupart étaient des cultivateurs dans l’ordre de 79,55%. Le principal motif de consultation était la rétention aigue d’urine(RAU) avec 72,73% et étiologies prostatiques (75%), comme geste d’urgence tous avaient bénéficiés d’un sondage vésical trans-urétral. CONCLUSION : La prise en charge des urgences urologiques représente une activité courante dans notre pratique. Ces urgences sont l’apanage du sujet âgé de sexe masculin et sont essentiellement dominées par les rétentions d’urine avec pour principales causes les tumeurs prostatiques. Le cathétérisme urétral est le geste le plus couramment pratiqué sachant qu’aucun cas d’obstruction urétral n’a été reçu.   Urological emergencies include a set of multiple and varied pathologies. They are more frequent in the elderly man because of prostatic affections and remain dominated by acute retention of urine, urogenital infections, and large purses. They can differ from one center to another on the epidemiological level, but also in the management. OBJECTIVE: To report the epidemiological and diagnostic aspects and to evaluate the management of urological emergencies in the SOUNON Séro hospital in Nikki. PATIENTS AND METHOD: This was a descriptive study with prospective data collection conducted at the SOUNON Séro hospital in Nikki over the period from November 5, 2020 to May 5, 2021, i.e. 6 months and involved 44 patients admitted to the emergency department for urological emergencies. The variables studied were: age, sex, profession, level of education, marital status, and clinical and therapeutic aspect. The data was collected on an individual collection sheet, and tested upstream, from hospital records, respecting ethical and deontological considerations. To analyze the data, SPSS version 2.0 software was useful and allowed us to obtain our results. RESULTS: The most represented age group was that of 60 – 74 years with 45.45% of which 100% were men and most were farmers in the order of 79.55%. The main reason for consultation was acute urinary retention (AUR) with 72.73% and prostatic etiologies (75%), as an emergency gesture, all had benefited from a transurethral bladder catheterization. CONCLUSION: The management of urological emergencies is a common activity in our practice. These emergencies are the prerogative of the elderly male subject and are essentially dominated by urine retention with the main causes being prostate tumors. Urethral catheterization is the most commonly performed gesture knowing that no case of urethral obstruction has been received

Aspects Epidemiologiques, Diagnostic, et Therapeutiques des Uegences Urologiques a l’Hospital Sounon Sero de Nikki

INTRODUCTION: Les urgences urologiques regroupent un ensemble de pathologies multiples et variées. Elles sont plus fréquentes chez l’homme âgé à causes des affections prostatiques et restent dominées par la rétention aigue d’urine, les infections urogénitales et les grosses bourses. Elles peuvent différer d’un centre à l’autre sur le plan épidémiologique, mais également dans la prise en charge. OBJECTIF : Rapporter les aspects épidémiologiques, diagnostique et d’évaluer la prise en charge des urgences urologiques dans l’hôpital SOUNON Séro de Nikki. PATIENTS ET METHODE: Il s’agissait d’une étude descriptive menée à l’hôpital SOUNON Séro de Nikki sur la période allant du 5 novembre 2020 au 5 mai 2021 et portait sur des patients admis dans le service des urgences pour des urgences urologiques. Les variables étudiées étaient : l’âge, le sexe, la profession, le niveau d’instruction, le statut matrimonial, aspect clinique et thérapeutique. Les données ont été collectées sur une fiche individuelle de collecte à partir des dossiers d’hospitalisation. Pour analyser les données, un logiciel SPSS version 2.0 nous a été utile et nous a permis d’obtenir nos résultats. RESULTATS : Dans notre étude la tranche d’âge la plus représenter est celle de 60 – 74 ans avec 45,45% dont 100% hommes et la plupart étaient des cultivateurs dans l’ordre de 79,55%. Le principal motif de consultation est la RAU avec 72,73% et étiologies prostatiques (75%), comme geste d’urgence tous ont bénéficiés d’un sondage urétro vésical.   CONCLUSION : La prise en charge des urgences urologiques représente une activité courante dans notre pratique. Ces urgences sont l’apanage du sujet âgé de sexe masculin et sont essentiellement dominées par les rétentions d’urine avec pour principales causes les tumeurs prostatiques. Le cathétérisme urétral est le geste le plus couramment pratiqué.   INTRODUCTION: Urological emergencies bring together a set of multiple and varied pathologies. They are more frequent in elderly men due to prostate diseases and are preserved by acute retention of urine, urogenital infections and large bursae. They may differ from one center to another on the epidemiological level, but also in supported. OBJECTIVE: Report the epidemiological aspects, diagnostic and evaluation aspects of the management of urological emergencies in the SOUNON Séro hospital in Nikki. PATIENTS AND METHOD: This was a descriptive study carried out at SOUNON Séro hospital in Nikki over the period from November 5, 2020 to May 5, 2021 on patients admitted to the emergency department for urological emergencies.The variables studied were: age, sex, occupation, level of education, marital status, clinical and therapeutic aspect. The data were collected on an individual collection sheet from hospitalization records. To analyze the data, SPSS version 20 software was useful and enabled us to obtain our results. RESULTS: In our study the most representative age group is that of 60 - 74 years with 45.45% of which 100% men and most of the farmers in the order of 79.55%. The main reason for consultation is RAU with 72.73% and prostatic etiologies (75%), as an emergency gesture all received a urethral bladder catheterization. Conclusion: The management of urological emergencies is a common activity in our practice. These emergencies are the prerogative of the elderly male subject and are mainly marked by urine retention, the main causes of which are prostate tumors. Urethral catheterization is the most common procedure

Paediatric urologic pathologies at the national teaching hospital in Cotonou: A etiological and therapeutic aspects

Background: Urological pathologies of children are dominated by congenital malformations of the kidneys and urinary tract. Their management is often surgical. The objective of this survey was to study etiological and therapeutic aspects of urological presentations in children. Patients and Methods: Data for aetiology, treatment, and results in children hospitalized at the Paediatric Surgery service of National Teaching Hospital (CNHU) in Cotonou were retrospectively analyzed from January 1999 to December 2008. Results: A total of 214 patients with complete data were evaluated. Urological pathologies represented 4.8% of the hospitalizations in paediatric surgery, with an incidence of 21 cases per year. The mean age was 4.9 ± 3.2 years (age 1 week to 14 years). The male to female ratio was 14:14. Cryptorchidism, hydrocele, nephroblastoma, the posterior urethral valves, ureteropelvic junction obstructions, post-circumcision haemorrhage and hypospadias were the most frequent pathologies. Congenital urological malformations represented 81.3%, followed neoplastic pathologies (7.9%), traumatic pathologies (6.1%) and others (4.7%). The disorders of male genitalia were more frequent and constituted 68.2% of the cases. The anomalies of the urinary tract were 30.8% and intersex disorders were 0.9%. The average age of the children urological pathologies at the time of consultation was 8.85 ± 4.6 years. The treatment was often surgical with a mortality of 2.8%

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Characteristics of HIV-2 and HIV-1/HIV-2 Dually Seropositive Adults in West Africa Presenting for Care and Antiretroviral Therapy: The IeDEA-West Africa HIV-2 Cohort Study.

HIV-2 is endemic in West Africa. There is a lack of evidence-based guidelines on the diagnosis, management and antiretroviral therapy (ART) for HIV-2 or HIV-1/HIV-2 dual infections. Because of these issues, we designed a West African collaborative cohort for HIV-2 infection within the framework of the International epidemiological Databases to Evaluate AIDS (IeDEA).We collected data on all HIV-2 and HIV-1/HIV-2 dually seropositive patients (both ARV-naive and starting ART) and followed-up in clinical centres in the IeDEA-WA network including a total of 13 clinics in five countries: Benin, Burkina-Faso Côte d'Ivoire, Mali, and Senegal, in the West Africa region.Data was merged for 1,754 patients (56% female), including 1,021 HIV-2 infected patients (551 on ART) and 733 dually seropositive for both HIV-1 and HIV 2 (463 on ART). At ART initiation, the median age of HIV-2 patients was 45.3 years, IQR: (38.3-51.7) and 42.4 years, IQR (37.0-47.3) for dually seropositive patients (p = 0.048). Overall, 16.7% of HIV-2 patients on ART had an advanced clinical stage (WHO IV or CDC-C). The median CD4 count at the ART initiation is 166 cells/mm(3), IQR (83-247) among HIV-2 infected patients and 146 cells/mm(3), IQR (55-249) among dually seropositive patients. Overall, in ART-treated patients, the CD4 count increased 126 cells/mm(3) after 24 months on ART for HIV-2 patients and 169 cells/mm(3) for dually seropositive patients. Of 551 HIV-2 patients on ART, 5.8% died and 10.2% were lost to follow-up during the median time on ART of 2.4 years, IQR (0.7-4.3).This large multi-country study of HIV-2 and HIV-1/HIV-2 dual infection in West Africa suggests that routine clinical care is less than optimal and that management and treatment of HIV-2 could be further informed by ongoing studies and randomized clinical trials in this population

Management and Outcomes Following Surgery for Gastrointestinal Typhoid: An International, Prospective, Multicentre Cohort Study

Background: Gastrointestinal perforation is the most serious complication of typhoid fever, with a high disease burden in low-income countries. Reliable, prospective, contemporary surgical outcome data are scarce in these settings. This study aimed to investigate surgical outcomes following surgery for intestinal typhoid. Methods: Two multicentre, international prospective cohort studies of consecutive patients undergoing surgery for gastrointestinal typhoid perforation were conducted. Outcomes were measured at 30 days and included mortality, surgical site infection, organ space infection and reintervention rate. Multilevel logistic regression models were used to adjust for clinically plausible explanatory variables. Effect estimates are expressed as odds ratios (ORs) alongside their corresponding 95% confidence intervals. Results: A total of 88 patients across the GlobalSurg 1 and GlobalSurg 2 studies were included, from 11 countries. Children comprised 38.6% (34/88) of included patients. Most patients (87/88) had intestinal perforation. The 30-day mortality rate was 9.1% (8/88), which was higher in children (14.7 vs. 5.6%). Surgical site infection was common, at 67.0% (59/88). Organ site infection was common, with 10.2% of patients affected. An ASA grade of III and above was a strong predictor of 30-day post-operative mortality, at the univariable level and following adjustment for explanatory variables (OR 15.82, 95% CI 1.53–163.57, p = 0.021). Conclusions: With high mortality and complication rates, outcomes from surgery for intestinal typhoid remain poor. Future studies in this area should focus on sustainable interventions which can reduce perioperative morbidity. At a policy level, improving these outcomes will require both surgical and public health system advances

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this

Use of Telemedicine for Post-discharge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review with Meta-analysis

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P<0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P<0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially