Bowel Anastomoses: Manual or Mechanical

An anastomosis is a connection between two tubular anatomical structures. Anastomoses have been a great surgical challenge from antiquities to modern times. Main research on the manual techniques and healing processes of digestive anastomoses took place during the 19th century. They were later improved by the advent of mechanical devices in the early 20th century. For both types of anastomoses, local and general conditions required for a good healing are the same. Many devices, both for manual and mechanical anastomoses have been developed. The devices’ uses depend on their availability, surgeons usual practice and the relative difficulty of the anastomosis. The debate is still lively about the advantages and the potential inconveniences of one technique versus the other in regards to many parameters such as operating time and the incidence of anastomotic leakage

Les fistules anastomotiques (FA) post-colectomie au Service de Chirurgie Générale de l’Hôpital Aristide Le Dantec

La fistule anastomotique reste la complication la plus redoutée après chirurgie colorectale et continue à poser un problème diagnostique et thérapeutique. Le but de cette étude est de déterminer à la fois la prévalence et les éléments de prises en charge diagnostiques et  thérapeutiques de la fistule colique après colectomie. Nous avons mené une étude rétrospective descriptive des cas de fistule colique après  colectomie sur une période de 7 ans allant de janvier 2007 au décembre 2013. Il y avait 17 patients qui ont présenté une fistule colique parmi les 170 patients ayant bénéficié de colectomie dans notre service soit un taux de 10%. L'âge moyen au moment de l'intervention initiale était de 45,1 ans (extrêmes de 20 et 78 ans). Il y avait une prédominance des patients de sexe masculin (n=13) avec un sex ratio de 3,3. Les pathologies tumorales colorectales (n=9) et le volvulus de colon pelvien (n=7) était les principales indications de colectomie L'intervention initiale a été réalisée en urgence chez 13 patients. Le délai moyen d'apparition de la fistule était de 10,8 jours. Il y avait 10 patients ayant présenté une fistule colo-cutanée et 7 cas de péritonites postopératoires stercorales. Onze de nos patients présentaient une anémie (taux moyen d'hémoglobine de 9,1 g/dl) et 8 patients, une hyperleucocytose (taux moyen de 15100  leucocytes/mm3). Une échographie, réalisée chez 6 patients, était revenue normale chez 1 patient et avait mis en évidence un épanchement intra péritonéal chez 5 patients tandis que La tomodensitométrie (TDM) sans opacification digestive, réalisée chez 2 patients, n'était contributive au diagnostic que chez 1 seul patient. Neuf patients avaient bénéficié de traitement médical seul. Ce dernier consistait en une couverture  antibiotique, un régime hyperprotéique, et un appareillage de la fistule par une poche de colostomie. La fistule s'est fermée spontanément, dans un délai moyen de 15 jours. La reprise chirurgicale a été réaliséechez 8 patients dans un délai moyen de 4,8 jours. Elle a été indiquée pour une péritonite par fistule anastomotique chez 7 patients et pour  persistance de la fistule colocutanée malgré traitement médical chez 1 patient. Le geste chirurgical consistait en une stomie digestive dans 6 cas. Sept patients ont présenté au moins une complication liée à la fistule colique (2 récidives de la fistule, 3 suppurations et 2 éviscérations). La durée moyenne d'hospitalisation était de 55,2 jours (extrêmes de 15et 168 jours). Deux décès étaient enregistrés consécutif à un choc septique. Une accessibilité des moyens thérapeutiques telles que la nutrition parentérale et le drainage percutané nous permettrait de réduire une durée d'hospitalisation prolongée et également des coûts de prise en charge élevés.Mots clés: Colectomie, anastomose, fistule, péritonite, stomi

Mistreatment in the gynaecology and obstetrics units of health facilities: community women's experiences in Guinea

Background: Improving maternal and child health helps to ensure women's well-being. However, despite many efforts, women are still subjected to mistreatment and abuse in health facilities such as gynaecology and obstetrics units. Data on women's mistreatment in gynaecology are scarce and insufficient in obstetrics departments. This study therefore analyses women's experiences of mistreatment in these services in Guinea. Methods: This study is based on a qualitative approach using in-depth individual interviews and group discussions with community women. The data was subjected to thematic analysis. Results: This study revealed a high prevalence of mistreatment of women in health facilities, both during provision of gynaecological services and in obstetric units (pregnancy, prenatal consultations and childbirth). They are mainly victims of verbal abuse, negligence and informal payment, and to a lesser extent physical violence. Victims generally have few means of redress. This mistreatment is encouraged above all by the lack of training for health care providers, the inadequacy of services and the absence of sanctions. To prevent and combat this phenomenon, it is necessary to organise training courses on respectful maternal care for healthcare providers, make patients aware of their rights and the culture of consent, and apply disciplinary sanctions. Conclusions: This study has enabled us to understand the types and extent of mistreatment suffered by women in obstetrics and gynaecology units.  It identified measures to be taken to prevent and combat mistreatment in these units in order to ensure respectful healthcare and improve relations between healthcare providers and their clients

Factors associated with decision-making on family planning use among women aged 15-49 in Guinea

Background: In Guinea, several factors affect women's ability to make decisions about contraceptive use. The objective of this study was to identify factors associated with married women's decision-making power regarding family planning use in Guinea. Methods: Data from the 2018 Guinea Demographic and Health Survey were used. A sample of 752 women was included in the study. Multivariate logistic regression was performed to determine the factors associated with women's decision-making power regarding the use of family planning in Guinea. The Odd ratio with 95% confidence interval was calculated for the variables in the final model. Results: The overall prevalence of women deciding to use family planning was 65.47% [95%CI: 62.18 68.61]. Urban women had a 49% lower chance of deciding to use family planning than rural women (adjusted OR=0.61; 95% CI [0.238 0.92]). Similarly, women with secondary education were 3.53 times more likely to use family planning than those with no formal education (adjusted OR=3.53; 95% CI [1.27 9.78]). Conclusions: This study shows the importance of several factors in women's decision-making power regarding family planning use in Guinea. Women with secondary education, those in the Kindia and Kankan regions, and those with a job had higher probability of deciding to use family planning. Findings from this study could help guide public health policies, emphasising the importance of education, employment and access to health services in improving women's decision-making power when it comes to family planning in the Republic of Guinea

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Processes for working-up an aqueous fluosilicic acid solution

Aqueous fluosilicic acid solutions were once considered to be only adverse by-products of phosphoric acid production, which required treatment to prevent ecosystem destruction when discharged into the sea. However, a range of chemicals can be generated by the transformation of this industrial waste product. Through experiments undertaken in the laboratory, we have shown the possibility of caustic soda production. Volumetric analysis showed caustic soda to be present as a 6% - 7% solution with yields of about 70% - 80% by weight. Two processes were investigated for the caustification of sodium fluoride, using different precipitates: sodium chloride and ethanol and are described by modelling caustification curves. The activation energies of precipitation determined by semi-empirical correlations showed that precipitation by ethanol (EA = 933.536 J/mol) was more successful than precipitation by sodium chloride(EA = 7452.405 J/mol). Analyses performed on the precipitates highlighted compositions that are essential and useful constituents in the cement industry

Processes for working-up an aqueous fluosilicic acid solution

Aqueous fluosilicic acid solutions were once considered to be only adverse by-products of phosphoric acid production, which required treatment to prevent ecosystem destruction when discharged into the sea. However, a range of chemicals can be generated by the transformation of this industrial waste product. Through experiments undertaken in the laboratory, we have shown the possibility of caustic soda production. Volumetric analysis showed caustic soda to be present as a 6%– 7%solution with yields of about 70% – 80%by weight. Two processes were investigated for the caustification of sodium fluoride, using different precipitates: sodium chloride and ethanol and are described by modelling caustification curves. The activation energies of precipitation determined by semi-empirical correlations showed that precipitation by ethanol (EA = 933.536 J/mol) was more successful than precipitation by sodium chloride (EA = 7452.405 J/mol). Analyses performed on the precipitates highlighted compositions that are essential and useful constituents in the cement industry

PERCUTANEOUS DRAINAGE : AN EFFECTIVE AND LESS AGRESSIVE APPROACH FOR COMPLICATED DIVERTICULAR ABSCESS

Retroperitoneal abscess is a serious complication of diverticular disease. Its management involves several options, ranging from conservative management to surgery. Elective colectomy is most often thought to be mandatory after a percutaneous drainage given the high rate of recidive. However, in patients with high risk for surgery, percutaneous drainage is often the main therapeutic alternative. We report a case of a 80-year-old woman, who was diagnosed to have a retroperitoneal abscess complicating a sigmoid diverticulitis. Ultrasound-guided percutaneous drainage allowed to drain 1500cc of pus and gas. The cytobacteriological examination was positive for: Streptococcus spp and Alkalescens dispar. The therapeutic outcomes were uneventful and despite we did not realize a colectomy because the patient was at high risk for surgery, there was no recidive after a 2-year-follow-up period. Percutaneous drainage can be a therapeutic alternative in patients with high risk for surgery in diverticular abscess of big size

Genomic Characterization of a Bataï Orthobunyavirus, Previously Classified as Ilesha Virus, from Field-Caught Mosquitoes in Senegal, Bandia 1969

Bataï virus (BATV), belonging to the Orthobunyavirus genus, is an emerging mosquito-borne virus with documented cases in Asia, Europe, and Africa. It causes various symptoms in humans and ruminants. Another related virus is Ilesha virus (ILEV), which causes a range of diseases in humans and is mainly found in African countries. This study aimed to genetically identify and characterize a BATV strain previously misclassified as ILEV in Senegal. The strain was reactivated and subjected to whole genome sequencing using an Illumina-based approach. Genetic analyses and phylogeny were performed to assess the evolutionary relationships. Genomic analyses revealed a close similarity between the Senegal strain and the BATV strains UgMP-6830 from Uganda. The genetic distances indicated high homology. Phylogenetic analysis confirmed the Senegal strain’s clustering with BATV. This study corrects the misclassification, confirming the presence of BATV in West Africa. This research represents the first evidence of BATV circulation in West Africa, underscoring the importance of genomic approaches in virus classification. Retrospective sequencing is crucial for reevaluating strains and identifying potential public health threats among neglected viruses

Impliquer le secteur de la santé dans la prévention et la prise en charge des mutilations génitales féminines: résultats d'une recherche formative en Guinée

Background: Despite efforts to reduce the burden of female genital mutilation (FGM) in Guinea, the practice remains prevalent, and health care providers are increasingly being implicated in its medicalization. This formative study was conducted to understand the factors that facilitate or impede the health sector in providing FGM prevention and care services to inform the development of health sector-based interventions. Methods: Between April and May 2018, a mixed methods formative study was carried out using a rapid assessment methodology in three regions of Guinea—Faranah, Labe and Conakry. A structured questionnaire was completed by one hundred and fifty health care providers of different cadres and 37 semi-structured interviews were conducted with health care providers, women seeking services at public health clinics and key stakeholders, including health systems managers, heads of professional associations and schools of nursing, midwifery, and medicine as well as representatives of the Ministry of Health. Eleven focus group discussions were conducted with female and male community members. Results: This study revealed health systems factors, attitudinal factors held by health care providers, and other factors, that may not only promote FGM medicalization but also impede a comprehensive health sector response. Our findings confirm that there is currently no standardized pre-service training on how to assess, document and manage complications of FGM nor are there interventions to promote the prevention of the practice within the health sector. This research also demonstrates the deeply held beliefs of health care providers and community members that perpetuate this practice, and which need to be addressed as part of a health sector approach to FGM prevention. Conclusion: As integral members of FGM practicing communities, health care providers understand community beliefs and norms, making them potential change agents. The health sector can support them by incorporating FGM content into their clinical training, ensuring accountability to legal and policy standards, and promoting FGM abandonment as part of a multi-sectoral approach. The findings from this formative research have informed the development of a health sector intervention that is being field tested as part of a multi-country implementation research study in Guinea, Kenya, and Somalia.SCOPUS: ar.jinfo:eu-repo/semantics/publishe