Morbi-Mortalité des Contusions Abdominales : La Face Visible de L’iceberg

Objectif : rapporter la morbimortalité des contusions abdominales (CA) à l’hôpital national de Niamey. Patients et méthode : il s’agissait d’une étude rétrospective, descriptive et analytique sur 4 ans incluant les patients pris en charge pour CA à l’hôpital national de Niamey. Les variables étudiées étaient le sexe, l’âge, le mode de traitement, les lésions abdominales, les lésions associées, la morbidité et la mortalité. Résultats : l’étude incluait 137 patients, soit 1,6% des urgences abdominales. Il s’agissait de 116 hommes et de 27 femmes avec un sex ratio de 5,52. L’âge moyen des patients était de 22,09 ±12,3 ans. Le délai moyen d’admission était de 18,4 ±26,3 heures. Les accidents de la voie publique représentaient 49,64% des circonstances de survenue du traumatisme. La CA était isolée chez 75,2% des patients et associée à une lésion extra-abdominale chez 24,8% des patients. Cette association lésionnelle réalisait un polytraumatisme chez 18,9% des patients. Les lésions abdominales étaient dominées par les lésions spléniques survenues chez 38,6% des patients, suivies par les lésions de l’intestin grêle chez 12,4% des patients. Une complication était survenue chez 10,9% des patients et 6,5% des patients étaient décédés à l’hôpital. La survenue de complications était influencée par le délai d’admission et la survenue d’une péritonite (p=0,002). L’hémorragie était la principale cause de décès. Conclusion : les CA constituent un traumatisme de l’adulte jeune de sexe masculin. La morbimortalité des CA n’est peut être que ‘’la face visible de l’iceberg’’. Objective : to report the morbidity and the mortality of the blunt abdominal trauma (BAT) at the national hospital of Niamey. Patients and method: it was a retrospective, descriptive and analytical study over 4 years including patients managed for BAT at the national hospital of Niamey. The variables analyzed were the age, sex, treatment, abdominal organs injury, associated injury, morbidity and mortality. Results: the study included 137 patients, whether 1.6% of abdominal emergencies. They were 116 men and 27 women, with a sex ratio of 5.52. The average age was 22.09[±12.3] years old. The average intake time was 18.43[±26.3] hours. Car crashes accounted for 49.64% of the circumstances of the trauma. The BAT was isolated in 75.2% of patients and associated to a (34) extra-abdominal trauma in 24.8% of patients. This lesional association achieved polytrauma in 18.9% of patients. The most abdominal organ injured was spleen in 38.6% of patients followed by small intestine in 12.4% of patients. The morbidity rate was 10.9% and the intrahospital mortality rate was 6.5%. The occurrence of morbidity was influenced by the intake time and the occurrence of peritonitis (p=0.002). Hemorrhage was the leading cause of death. Conclusion: BAT are most frequent in young male adults at national hospital of Niamey. The morbimortality of BAT is perhaps ‘’the visible face of the iceberg’’

Cholécystectomies Laparoscopiques Pour Cholécystite Aigue Lithiasique Versus Lithiase Vésiculaire Symptomatique

Introduction: The aim of this work was to highlight the therapeutic and prognostic difficulties between a laparoscopic cholecystectomy for acute gallstone cholecystitis (CAL) and uncomplicated symptomatic vesicular lithiasis (LVS) as well as the reasons for conversion to laparotomy. Patients and Methods: This was a prospective comparative and analytic study over 18 months. Patients admitted and operated for CAL or LVS in the A Surgery Department of the National Hospital of Niamey (HNN) were included. Results: The study involved 61 patients divided into two groups. Group 1 (30 patients) corresponding to patients operated for CAL, group 2 (31 patients) corresponding to patients operated for LVS. Laparoscopic cholecystectomy accounted for 61% of all cholecystectomies performed and 1.45% of surgical activity during the same period. The average age in group 1 was 43.7 years with extremes of 14 and 61 years. In group 2, the average age was 38.9 years with extremes ranging from 12 to 55 years. Women were predominantly represented with 63.3% and 96.7% respectively for groups 1 and 2. Patients were overweight in 9 cases for group 1 (30% of cases) and 12 cases in group 2 (38%), 7% of cases). Hepatic colic was the main sign of appeal in all patients in both groups. In group 1; 26 out of 30 cases or 86.7% of cases had leukocytosis, whereas in group 2, leukocytosis was normal in 30 cases, ie 96.8% of cases. Accessibility of the vesicle was difficult in 73.3% of cases in group 1 against 22.6% of cases in group 2. The vesicle was distended and necrotic in groups 1 in 76.7% and 10 respectively. % of cases. On the other hand, in 25.8% of cases, the vesicle was distended and without any necrosis in group 2. The rate of conversion to laparotomy was 6.55% (4 cases) and exclusively concerned group 1. Operative follow-up immediate outcomes were simple in 98.34% of cases. The complications involved 2 patients in group 1 (1.66% of the total), including parietal suppuration and biliary leakage. Mean operative time was 68.7 min in group 1 versus 41.6 min in group 2. Mean duration of hospitalization was 4.3 days with extremes between 2 and 10 days in group 1 versus1,7 days with extremes ranging from 1 to 7 days in group 2. Mortality was zero. Conclusion: In recent years, laparoscopic surgery has made remarkable progress in Niger. Laparoscopic cholecystectomy seems to be more difficult to perform with significant morbidity in the case of CAL than LVS. The risk of per and postoperative complications can be estimated from the clinical data (acute cholecystitis or symptomatic vesicular lithiasis) and the surgeon's experience. In a cholecystectomy that lasts more than 2 hours, the cumulative risk of complications is highe

Prise En Charge Des Anévrismes Artériels Dans Un Centre Africain Non Spécialisée

Introduction: Arterial aneurysms affect 7 to 8% of people over 65 in the West and are the 2nd leading cause of death in these countries. In Africa this frequency is poorly evaluated. The objective of this work is to report the management of arterial aneurysms at the National Hospital of Niamey (HNN). Patients and methods: This was a retrospective, descriptive study over a period of eight (8) years from January 2009 to December 2016, performed in the surgical departments of the National Hospital of Niamey. Included in the study were patients of both sexes, hospitalized and / or operated for arterial aneurysm. Not included were patients treated for arterial aneurysm with incomplete records or those concerning the neurosurgical sphere. Results: During the study period, 17,748 patients were hospitalized in the general surgery departments, including 16 patients for arterial aneurysm, or 0.09% of surgical pathologies. There were 13 men (81.25%) and 3 women (18.75%), or a sex ratio of 4.33. The average age was 55.75 years with extremes ranging from 25 years old to 90 years old. The circumstances of discovery of the aneurysms were swelling of the antero-internal aspect of the thigh in 7 cases (43.75%), abdominal mass 6 cases (37.50%), then 2 cases (12.50%) of chest pain and incidental discovery in 1cas (6.25%). The most common risk factor was high blood pressure with 43.75% (7 cases). The aneurysm sat on the femoral artery in 43.75% (n = 7), of which 6 on the deep femoral and 1 on the superficial femoral, on the infrarenal aorta in 31.25% (n = 5), on thoracic aorta 12.50% (n = 2), on the iliac artery 12.50% (n = 2). For the diagnosis the angioscanner is realized in all the patients and in addition Doppler ultrasound in 43, 75% of cases. Twelve (12) patients benefited from curative surgical intervention by prosthetic graft by PTFE in 58.33% of cases and by Dacron in 41.66%. The average stay was 29.75 days and the immediate operative followup was complicated by thrombosis in 12.5% and parietal suppurations in 6.25%. We recorded two (2) deaths, ie 12.5% among non-operated patients. Conclusion: Arterial aneurysms are rare diseases at the HNN. Conventional surgery is the treatment performed in our patients. The postoperative course was simple in most cases

Pilot feasibility study of an emergency paediatric kit for intra-rectal quinine administration used by the personnel of community-based health care units in Senegal

<p>Abstract</p> <p>Background</p> <p>Quinine injection is the reference treatment for malaria when oral administration is impossible. Quinine can also be administered by the intra-rectal route and, over the last ten years, a series of studies have been conducted in children to determine the ideal dose and dilution in the African situation. The aim of the present study was to evaluate the feasibility and usefulness of a kit for an immediate administration of quinine alkaloids (Quinimax^®) by community health workers, prior to transfer of the child to a more sophisticated health care establishment.</p> <p>Methods</p> <p>A prospective, open, descriptive community intervention study conducted in northern Senegal at six village Health Units in children fewer than ten years of age with non-per-os malaria. Controls were given the routine care prior to transfer to a Health Center, and cases were in addition administered Quinimax^®(20 mg/ml) via the intra-rectal route before transfer. Patients were followed through complete cure and parasitological tests were carried out on Days 0, 3 and 7.</p> <p>Results</p> <p>134 patients (79 cases/55 controls) were recruited between November 2003 and May 2004 or October and November 2004. The two groups were comparable at inclusion. In the case group, oral drugs could be administered after a mean of <it>16.8 hours </it>versus <it>33.6 hours </it>in the control group. Time-to cure was shorter in cases than in controls. Complete parasite clearance was obtained in all patients by Day 7. The kit was well accepted by all concerned and more than 80% of community health workers judged the kit easy to use.</p> <p>Conclusion</p> <p>The emergency paediatric kit is a useful tool in the management of malaria in children who cannot be treated orally. It is feasible and easy to use for health workers in community-based Health Units where, according to the WHO, nearly 80% of malarial morbidity and mortality occurs.</p

System of crop intensification for more productive, resource-conserving, climate-resilient, and sustainable agriculture: experience with diverse crops in varying agroecologies

With continually increasing demand for food accompanied by the constraints of climate change and the availability and quality of soil and water, the world’s farmers are challenged to produce more food per hectare with less water, and with fewer agrochemical inputs if possible. The ideas and methods of the system of rice intensification which is improving irrigated rice production are now being extended/adapted to many other crops: wheat, maize, finger millet, sugarcane, tef, mustard, legumes, vegetables, and even spices. Promoting better root growth and enhancing the soil’s fertility with organic materials are being found effective means for raising the yields of many crop plants with less water, less fertilizer, reduced seeds, fewer agrochemicals, and greater climate resilience. In this article, we review what is becoming known about various farmer-centred innovations for agroecological crop management that can contribute to agricultural sustainability. These changes represent the emerging system of crop intensification, which is being increasingly applied in Asian, African, and Latin American countries. More research will be needed to verify the efficacy and impact of these innovations and to clarify their conditions and limits. But as no negative effects for human or environmental health have been identified, making these agronomic options more widely known should prompt more investigation and, to the extent justified by results, utilization of these methodologies

A Theoretical Analysis of the Geography of Schistosomiasis in Burkina Faso Highlights the Roles of Human Mobility and Water Resources Development in Disease Transmission

We study the geography of schistosomiasis across Burkina Faso by means of a spatially explicit model of water-based disease dynamics. The model quantitatively addresses the geographic stratification of disease burden in a novel framework by explicitly accounting for drivers and controls of the disease, including spatial information on the distributions of population and infrastructure, jointly with a general description of human mobility and climatic/ecological drivers. Spatial patterns of disease are analysed by the extraction and the mapping of suitable eigenvectors of the Jacobian matrix subsuming the stability of the disease-free equilibrium. The relevance of the work lies in the novel mapping of disease burden, a byproduct of the parametrization induced by regional upscaling, by model-guided field validations and in the predictive scenarios allowed by exploiting the range of possible parameters and processes. Human mobility is found to be a primary control at regional scales both for pathogen invasion success and the overall distribution of disease burden. The effects of water resources development highlighted by systematic reviews are accounted for by the average distances of human settlements from water bodies that are habitats for the parasite's intermediate host. Our results confirm the empirical findings about the role of water resources development on disease spread into regions previously nearly disease-free also by inspection of empirical prevalence patterns. We conclude that while the model still needs refinements based on field and epidemiological evidence, the proposed framework provides a powerful tool for large-scale public health planning and schistosomiasis management

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Séchage statique des céréales à basse temperature. Utilisation de toitures solaires pour séchoir à maïs

Low temperature grain drying is a good technic for agriculture. A mathematical model for a solarised silo has been chosen then experimentally validated. Drying sessions can be simulated to find parameter sensibility or optimal design for the dryer. The comparison criterion used, is the specific consumption, CS, the necessary energy to extract one kilo of water out of grain. The CS is always compared with traditional fuel dryer. According to working conditions, the drying may be economic, but it is necessary to control carefully the dryer.Le séchage du grain à basse température dans un silo de stockage, est une technique qui semble convenir aux agriculteurs de nombreux pays en particulier aux USA. Pour essayer de déterminer l'intérêt économique de la solarisation du silo, un modèle mathématique du séchoir à été choisi puis validé expérimentalement. Des opérations de séchage peuvent alors être simulées dans le but de déterminer soit la sensibilité des paramètres utilisés, soit le design optimal du silo. La consommation spécifique, CS, énergie nécessaire à l'extraction d'un kilo d'eau du grain, sert de critère de comparaison entre les séchoirs solaires et les séchoirs à fuel traditionnels. Suivant les conditions de fonctionnement, l'opération peut être plus ou moins rentable, donc la conduite de l'opération implique de bien maîtriser la conduite du séchage