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The Management of Neonatal Peritonitis in the Paediatric Surgery Department of the Donka National Hospital

Open Journal of Pediatrics 2024年第5期14卷 823-833页

作者： mohamed lamine Sadou Sacko Thierno Saidou Barry Balla Keita Mory Sangare Jacques Faya Millimono Moussa Conde Seydou Keita Daniel Agbo-Panzo Pediatric Surgery Department at Conakry University Hospital Conakry Guinea Universit Gamal Abdel Nasser de Conakry Conakry Guinea General Surgery Department Ignace Deen University Hospital Conakry Guinea

Introduction: Neonatal peritonitis is a rare but serious condition requiring early diagnosis and management. The lack of antenatal diagnosis, the precariousness of neonatal intensive care, and the delay in diagnosis and treatment are the factors of poor prognosis. The objective of this study was to study the epidemiological, diagnostic and therapeutic aspects of neonatal peritonitis in order to improve its management in the pediatric surgery department of the CHU-Donka. Materials and Methods: This is a retrospective descriptive study of the records of patients treated for neonatal peritonitis from January 1, 2017 to December 31, 2022. Results: Results: We compiled 17 records of patients operated on for neonatal peritonitis, representing a frequency of 3.85% and an incidence of 2.83 cases/year. The mean age of our patients was 8.29 days, with extremes of D0 and D25. Males were more dominant, with a frequency of 71% and a sex ratio of 2.4. The average consultation time was 72 h, with extremes of 12 h and 144 h. Abdominal bloating was the main reason for consultation (100%). Fever and vomiting were frequent, at 70.59% and 82.35% respectively. PSA revealed pneumoperitoneum in 12 patients (70.59%). The colon was the most frequent site of perforation at 29.41%. ECUN was the main etiology with 35.29%. Ostomy was the main surgical procedure in 58.82% of cases, followed by suture excision in 29.41%. Postoperative follow-up was simple in 3 patients (17.65%) and complicated in 14 (82.35%). Sepsis was the main cause of death (47.59%). The mortality rate was 76.47%. Conclusion: Mortality from neonatal peritonitis remains high in developing countries. Early diagnosis, early surgical management, and the presence of well-equipped neonatal intensive care units with qualified staff are essential for an improvement in the prognosis of neonatal peritonitis.

关键词： Etiology Newborns Gastrointestinal Perforation

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Management of Acute Idiopthic Intestinal Invaginal in Infants at Conakry University Hospital

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Open Journal of Pediatrics 2024年第5期14卷 937-950页

作者： Thierno Saidou Barry mohamed lamine Sadou Sacko Balla Keita Mory Sangare Fanta Kourouma Moussa Conde Baldé Aissatou Bailo Seydou Keita Daniel Agbo-Panzo Pediatric Surgery Department of the Conakry University Hospital Conakry Guinea Gamal Abdel Nasser University of Conakry Conakry Guinea Pediatrics Department Albert Royer Childrens Hospital Cheikh Anta Diop University of Dakar (UCAD) Dakar Senegal General Surgery Department of the Ignace Deen University Hospital Conakry Guinea

Introduction: Acute intestinal intussusception (AII) has been known for a long time but its diagnosis sometimes remains difficult and its etiologies, particularly the idiopathic forms, poorly elucidated. The objective of this study was to describe the clinical and therapeutic aspects of acute intestinal intussusception in order to contribute to the improvement of the management of this condition in the pediatric surgery department of the Donka National Hospital. Materials and Methods: This is a retrospective descriptive study of patients taken in charge of acute idiopathic intestinal intussusception over a period of 7 years (January 2017 to December 31, 2023). Results: We collected 72 patients operated on for IIA, i.e. a hospital frequency of 1.1% and an incidence of 10.3 cases per year. The mean age was 16.58 months with extremes of 3 months and 28 months. The sex ratio was 12.5 in favor of the boy. The triad of ombredanne dominated the clinical picture and paroxysmal abdominal pain with period of calm represented the main reason for consultation (72 cases) i.e. 100%, followed by vomiting (62 cases) and rectal bleeding (50 cases). Ultrasound was performed in 56 patients visualizing the intussusception sausage in 54 patients or 75%. The most common anatomoclinical variety of intussusception was the ileo-caeco-colic form with 35 cases (or 38%) followed by the ileocolic form 24 cases (33%). The surgical procedure performed was a manual reduction in 54 patients or 75% and an anastomosis resection in 18 patients;the appendectomy of principle was done in 62.25%. The postoperative course was simple in 64 patients or 88.88%. The mortality rate was 6.94 %. Conclusion: AII is a common abdominal surgical emergency in infants. Recognition of the Ombredanne triad especially abdominal pain with a period of calm in children and infants in particular is an important element for vital prognosis. Early diagnosis and close interdisciplinary cooperation between pediatric, radiology an

关键词： Acute Idiopathic Intussusception Infant Intussusception Sausage Pediatric Surgery

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Contribution of Bone Scintigraphy in the Metastatic Extension Assessment of Prostate Cancer: A Study of 288 Cases in the Nuclear Medicine Department of Idrissa Pouye General Hospital, Dakar

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Open Journal of Biophysics 2024年第2期14卷 79-98页

作者： El Hadji Amadou lamine Bathily Ousseynou Diop Mamoudou Salif Djigo Gora Thiaw Kalidou Gueye mohamed Chekhma Olatounde Herbert Fachinan Boucar Ndong Omar Ndoye Mamadou Mbodj Department of Nuclear Medicine Idrissa Pouye General Hospital (HOGIP) Dakar Senegal Biophysical Laboratory FMPO Cheikh Anta Diop University (UCAD) Dakar Senegal Department of Nuclear Medicine Hospital Dalal Jamm Dakar Senegal

Introduction: Prostate cancer is the most frequently diagnosed male malignancy and the fifth leading cause of cancer death in men worldwide. Since the advent of screening methods such as Prostate Specific Antigen (PSA) assay, digital rectal examination (DRE) and prostate biopsy, its incidence has increased significantly. The aim of our study was to analyse aspects of bone scintigraphy (BS) as part of the metastatic extension assessment of prostate cancer in Senegal. Patients and Methods: This was a retrospective descriptive and analytical study, running from January 1er 2022 to August 31 2023. Patients with histologically confirmed prostate cancer were included. Whole-body scans (WBS) were performed using a dual-head SPECT gamma camera (Mediso Nucline TM Spirit DH-V type), 3 hours after intravenous injection of 8 MBq/kg (555 to 740 MBq) of 99mTc-HMDP. Results: A total of 288 patients with a mean age of 68.37 ± 7.79 years were included. The median total PSA level was 97.6 ng/ml, with 144 patients having a level greater than or equal to 20 ng/ml. All patients had adenocarcinoma, and the Gleason score was available in 202 (70.13%) patients, 75.75% of whom had a score greater than or equal to 7. BS was contributory in 70.48% of cases, with 30.90% positive and 39.58% negative. The result was inconclusive in 85 patients (29.51%). The mean PSA for patients with a positive scan was 190.2 ng/ml and 40.6 ng/ml for those with a negative scan. Multiple metastatic lesions predominated (87.35% of cases). Metastatic lesions occurred preferentially in the axial skeleton, with a proportion of 68% versus 32% in the appendicular skeleton. Classification of bone metastases according to the SOLOWAY score revealed grade I (62.07%), grade II (35.63%) and grade IV (2.30%). Conclusion: In Senegal, prostate cancer is generally diagnosed in men of advanced age. The presence of bone metastases is frequent in its evolution, transforming a curable localized disease into a g

关键词： Prostate Cancer Bone Metastasis Bone Scintigraphy Senegal

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Surgical Treatment of the Upper Urinary Tract Lithiasis at the Urology Department of the Hopital General Idrissa Pouye

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Open Journal of Urology 2024年第5期14卷 290-300页

作者： Mouhamadou Moustapha Mbodji mohamed Jalloh Medina Ndoye Abdou Fall Cheikh Gassama Babou Sakho Serigne Mbacké Ndiaye Moussa Sene Abdourahmane Diallo Issa Labou lamine Niang Department of Urology and Andrology Hopital General Idrissa Pouye Dakar Senegal

Upper urinary tract lithiasis is a condition characterized by the presence of stones which is a stony concretion of crystallized substances in the kidney and/or ureter. Objective: The objective of this work is to study the epidemiological, clinical and therapeutic aspects of upper urinary tract stones on the one hand, then to compare the different types of surgical treatments and their results. Materials and Methods: This is a retrospective and descriptive study focusing on the surgical management of upper urinary tract stones, between January 2017 and December 2020, at the Urology department of the Hopital General Idrissa Pouye. Results: During the study period, 7.59% of surgical interventions performed were related to the treatment of upper urinary tract stones. Average age was 45.20 ± 16.4 years, the age group [41 - 60] years was more affected with 42.68%. A history of urolithiasis was present in 25.52% of cases. Lower back pain was present in 97.48% of cases. On URO-CT scan, the stone was located more at the level of the ureter (49.57%). The size between 10 to 15 mm was more frequent (30.96%) and the density greater than 1000 HU was more frequent (33.47%). The most used therapeutic procedure was ureteroscopy (52.08%), followed by PCNL (40.83%) and open surgery (7.08%). The success rate (stone free) was 93.68% for the URS, 89.36% for the PCNL. The length of hospital stay for open surgery was 6.76 ± 4.25, for PCNL 2.62 ± 2 days and for URS 1.75 ± 1.62 days. Postoperative complications were present in 23.52% for open surgery, 11.22% for PCNL and 8% for URS. Conclusion: Urolithiasis is constantly growing in our regions. Effective endourological treatment is increasingly replacing open surgery. However, global access to these new techniques in our regions is slow to be effective.

关键词： Endo-Urology Open Surgery Renal Lithiasis Ureteral Lithiasis URO-CT Scan

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Congenital Cervico-Mandibular Cystic Lymphangioma in Pediatric Surgical Setting in Guinea

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Open Journal of Pediatrics 2024年第1期14卷 164-173页

作者： Thierno Saïdou Barry mohamed lamine Sadou Sacko Balla Keita Aissatou Bailo Balde Mamadou Alpha Diallo Moussa Conde Ibrahima Kalil Dioubate Mory Sangare Salamata Sall Mariama Dalanda Diallo Daniel Agbo-Panzo Pediatric Surgery Department Donka National Hospital (HND) of Conakry University Hospital (Gamal Abdel Nasser University of Conakry (UGANC) of Guinea) Conakry Guinea Hadja Bilguissou BARRY Medical-Surgical Clinic (HBB) Conakry Guinea Albert Royer Children’s Service Cheikh Anta DIOP University (UCAD) Dakar Senegal Surgery Department of the Regional Hospital Center of Ziguinchor (CHRZ) Ziguinchor Senegal

Introduction: Cystic lymphangiomas are rare benign malformative tumors of the lymphatic system of obscure etiopathogenesis. The cervico-facial location remains the most common (75%). Although benign, these tumors remain potentially fatal, due to possible compression of the upper aero-digestive tract. The aim of this work is to study the epidemiological, diagnostic and therapeutic characteristics of cervico-mandibular congenital cystic lymphangiomas in the pediatric surgery department of the Donka National Hospital (HND) Conakry. Patients and methods: This is a retrospective and descriptive study of 13 files lasting 7 years from January 2015 to December 31, 2021. The files of children whose age is less than or equal to 15 years operated on cervical tumor with histological evidence of cystic lymphangioma were retained. The data were analyzed using SPSS statistical software 21 and anonymously. Results: The incidence of this study was 1.86 cases per year and a sex ratio of 0.62 in favor of girls. The average age was 8 months 19 days. In the antecedents, we only find poorly monitored pregnancies. The average size of the tumors was 11.85 cm. Cervical ultrasound and standard x-ray of the cervical mass were the only examinations performed. Total surgical excision of the cervical tumor was performed in all patients. The mass was polycystic on exploration. The histological examination of the surgical specimens was in favor of a cystic lymphangioma. The surgical consequences were simple in 11 patients (84.62%) and complicated by parietal suppuration in 2 cases (15.38%). There were no cases of recurrence after one year of follow-up. Conclusion: Cervico-mandibular cystic lymphangiomas are the most frequent locations of congenital lymphangiomas in children. Their severity is linked to the risk of compression of the aero-digestive tracts. Their diagnosis must be confirmed by the histology of the surgical specimen. Despite the therapeutic arsenal, excision of the cystic mass remain

关键词： Congenital Cystic Lymphangioma (LKC) Child Pediatric Surgery Guinea

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Gastrointestinal Ulcers Treatment: Plants and Recipes Used by Herbalists of Abomey-Calavi and Cotonou Districts, Southern Benin

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American Journal of Plant Sciences 2024年第9期15卷 699-725页

作者： Brice Dangnon Durand Dah-Nouvlessounon Sêmassa mohamed Ismaël Hoteyi Abdelmalick Abdelrahman Moubachar Abdelkerim Mahamat Nicodème Worou Chabi Sina Haziz Farid Baba-Moussa Adolphe Adjanohoun lamine Baba-Moussa Laboratory of Biology and Molecular Typing in Microbiology Department of Biochemistry and Cell Biology Faculty of Science and Technology University of Abomey-Calavi Cotonou Benin Unit of Biochemistry and Molecular Markers in Nutrition Laboratory of Research in Applied Biology Polytechnic School of Abomey-Calavi University of Abomey-Calavi Cotonou Benin Laboratoire de Microbiologie et de Technologie Alimentaire Faculty of Science and Technology University of Abomey-Calavi Cotonou Benin Institut National des Recherches Agricoles du Bnin Cotonou Benin

This study set out to identify plants and recipes used by herbalists in the municipalities of Abomey-Calavi and Cotonou to treat gastrointestinal ulcers and to characterize the distribution of their knowledge. An ethno-pharmacological survey was carried out in which informants who agreed freely were interviewed using a semi-structured questionnaire. A total of 85 herbalists were surveyed. The data were processed with Microsoft Excel to calculate the relative frequencies of citation of the various species mentioned by the herbalists and various indices including Simpson’s Index were adapted to test the distribution of their knowledge. Multiple regression and correspondence analysis were performed using R studio. Our results revealed that the Dendi, Ifè and Mina, all equitable in their knowledge of anti-ulcer plants, are likely to know more than the other ethnic groups. On the other hand, respondents practicing Islam are more likely to know many antiulcer plants than those practicing Vodoun and Christianity. This constant distribution of knowledge of anti-ulcer plants among the Dendi, Ifè and Mina, three different ethnic groups seems normal and attests to the fusion between these different ethnic groups in view of this knowledge. A total of 70 anti-ulcer recipes, made from 71 species of medicinal plants or non-floristic resources were recorded. Vitellaria paradoxa, Parkia biglobosa and Ocimum gratissimum were the top 03 most frequently cited in descending order of frequency. All the species cited are grouped into 44 botanical families among which the Fabaceae, Lamiaceae and Sapotaceae were strongly represented. Benin’s flora abounds in a diversity of medicinal plant species known to herbalists in Abomey-Calavi and Cotonou for the treatment of gastrointestinal ulcers. The results of this study constitute a good archive for the selection of plant species for in-depth studies with a view to formulating improved traditional medicines for gastrointestinal ulcers.

关键词： Gastrointestinal Ulcer Ethnomedicine Herbalist Nature Plant Material

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Evaluation of the Integrated Management Program for Acute Malnutrition in the Douentza Health District, Mopti Region, Mali

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Food and Nutrition Sciences 2024年第8期15卷 790-806页

作者： Abdoul Salam Diarra lamine Traore mohamed Diarra Tawfiq Abu Mamadou Traore Yacouba Guindo Sidi Sangare Seydou Kante Intimbeye Tembine Dramane Coulibaly Mamadou Fodé Diarra Salia Keita Sadio Sambala Diallo Mamadou Samake Hamadoun Sangho National Center for Scientific and Technological Research Bamako Mali Division of Nutrition Regional Directorate of Health and Public Hygiene Mopti Mali Department of Pediatric Health Referral Center of Kalaban Coro Koulikoro Mali Private Practice for Family and Emergency Medicine Casablanca Morocco Division of Nutrition General Directorate of Health and Public Hygiene Bamako Mali Administration Department Health Referral Center of Djenne Mopti Mali Administration Department Health Referral Center of Douentza Mopti Mali Administration and Planning Department Regional Health Directorate Mopti Mali Division of Health Department Regional Health Directorate of Mopti Mopti Mali Golden Life American Hospital Bamako Mali Department of Public Health Faculty of Medicine and Odontostomatology University of Sciences Techniques and Technologies of Bamako Bamako Mali

Introduction: Malnutrition is a major public health problem in Mali, despite the efforts of the government, its technical and financial partners. The aim of this study was to evaluate the integrated management program for acute malnutrition (IMPAM). Methodology: This was a descriptive cross-sectional study that took place from January to December 2020 in the Douentza health district. The study included anyone with at least one malnourished child aged 6 to 59 months in their care who agreed to take part in the study, community health center staff who had given their consent, and the URENI manager at the Douentza reference health center. Data collected via questionnaires were entered into Excel and then analyzed using Epi-Info version 7 software. Results: A total of 138 acutely malnourished children aged 6 - 59 months, including 71 girls (51.45%), 138 accompanying mothers and 11 health workers, were included in our case study. Among the malnourished, 54.34% were in the 12 - 23 months age group and 69.57% had the severe form. 93% of the mothers interviewed were satisfied with the care provided, and all the health staff interviewed stated that community conflicts had an impact on IMPAM’s activities. Cure rates were 81% in Moderate Outpatient Nutritional Recovery and Education Unit (URENAM), 84% in Severe Ambulatory Nutritional Recovery and Education Unit (URENAS) and 92% in Recovery and Intensive Nutritional Education Unit (URENI). Drop-out rates were 19% in URENAM, 16% in URENAS and 0% in URENI. The death rate was 8% in URENI and 0% in URENAM and URENAS. Conclusion: This study confirms the high prevalence of malnutrition in the district (10.54%). It also reveals that factors such as inter-community conflict and insecurity have seriously affected the IMPAM program.

关键词： Care Acute Malnutrition Children Aged 6 - 59 Months IMPAM Douentza

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Complications of Corticosteroid Therapy in Rheumatological Practice in Guinea

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Open Journal of Rheumatology and Autoimmune Diseases 2024年第3期14卷 108-117页

作者： Aly Badra Kamissoko Eve Urielle Amenan Ledjou Mamadou lamine Diallo Abèni Faouzyath Yaya mohamed Mouhoudhoiri Yasser Aboubacar Sidiki Condé Souleymane Camara Marie Traoré Abdoulaye Barry Moriba Touré Kaba Condé Owonayo Oniankitan Department of Rheumatology Ignace Deen University Hospital Conakry Guinea Department of Rheumatology Cocody University Hospital Abidjan Cte dIvoire Department of Rheumatology Sylvanus Olympio University Hospital Lom Togo

Introduction: Corticosteroid therapy used in rheumatology is effective but can lead to complications. The objective was to describe the complications of corticosteroid therapy in rheumatological practice at Ignace Deen University Hospital (Conakry). Methods: Cross-sectional study from July 1, 2022 to March 31, 2023. All patients who had been diagnosed with a rheumatological disease and who had received corticosteroid therapy were included. Results: Of the 1489 patients suffering from rheumatological diseases, 238 (15.9%) had received corticosteroid therapy. The average age of the patients was 48.5 ± 17.16 years with a female predominance (70.5%). The main indications for corticosteroid therapy were lower back pain due to probable disco-radicular impingement (35.8%) followed by rheumatoid arthritis (21.9%). The predominant method of administration was infiltration (56.9%). The average dosage was 24.2 ± 13.5 mg prednisone equivalent (range: 5 mg and 40 mg). Complications were present in 26 patients (10.9%) such as muscle cramps (3.8%), hypocalcemia (3.4%), edema of the lower limbs (3%), stimulation of appetite and weight gain (3%), high blood pressure (2.5%), hyperglycemia (2.5%). The occurrence of complications was associated with the high dose of corticosteroid (p = 0.014) and long-term use (p = 0.000). Conclusion: Corticosteroid therapy used in 15.9% of consultations in the rheumatology department of Ignace Deen University Hospital led to 10.9% of complications. These complications were related to the dose and duration of corticosteroid therapy.

关键词： Corticosteroids Complications Guinea

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Causes and Prognosis of Cases of Acute Obstructive Renal Failure Managed at the Donka National Hemodialysis Center

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Open Journal of Nephrology 2024年第2期14卷 136-146页

作者： Amadou Yaya Diallo Mamadou Mouctar Diallo Mamadou Dian Barry Kadiatou Mamadou Bobo Barry Saikou Oumar Diallo Djenabou Diallo Soriba Bangoura Mamadou Malal Diallo Thierno Mamadou Oury Diallo mohamed lamine Kaba Alpha Oumar Bah Department of Nephrology-Hemodialysis CHU Donka Conakry Guinea Faculty of Health Sciences and Techniques Gamal Abdel Nasser University of the Republic of Guinea Conakry Guinea Department of Urology-Andrology CHU Ignace Deen Conakry Guinea

Introduction: Acute obstructive renal failure (AORF) is a frequent clinical situation, secondary to obstruction of the urinary excretory tract. Whatever the cause, urinary tract obstruction suddenly opposes glomerular filtration and is responsible for tubulointerstitial lesions. It accounts for 10% of acute renal failure (ARF). The aim of this study was to identify the causes and prognosis of cases of acute obstructive renal failure managed at the Centre National d’hémodialyse Donka. Material and Methods: This was a prospective descriptive study lasting 6 months, from September 1, 2022 to February 29, 2023. All patients undergoing haemodialysis for acute obstructive renal failure who agreed to participate in the study and whose medical records were complete were included. Results: During the course of the study, we registered 97 haemodialysis patients, including 20 cases (20.62%) of acute obstructive renal failure. The mean age of the patients was 57.8 ± 10.54 years, with a male predominance of 11 cases (55%) and a sex ratio of 1.22. The reasons for consultation were dominated by physical asthenia 11 cases (55%), lumbar pain 9 cases (50%), vomiting 6 cases (30%) and acute urine retention 6 cases (30%). Arterial hypertension 16 cases (80%) and urinary tract infection 10 cases (50%) were the most common antecedents. The etiologies of RAOI were dominated by lithiasis 10 cases (50%), neoplasia 6 cases (30%) and benign prostatic hypertrophy 3 cases (15%). mean creatinine was 1267.60 ± 710.76 μmol/l with extremes of 243 μmol/l and 2822 μmol/l, mean urea was 39.56 ± 18.36, hyperkalemia in 14 cases (70%) and hyponatremia in 8 cases (40%). After hemodialysis, 9 cases (45%) recovered renal function, 4 cases (20%) became chronic and 7 cases (35%) died. Conclusion: The frequency of AKI remains non-negligible in our department, and early detection and prompt management would considerably reduce the morbidity and mortality associated with this pathology.

关键词： Acute Obstructive Renal Failure Hemodialysis Prognosis Donka

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Eyelid Wounds: Epidemiological, Clinical and Etiological Aspects

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Open Journal of Ophthalmology 2024年第1期14卷 55-62页

作者： Aly Mbara Ka Jean Pierre Diagne Aissatou Aw El Hadji Malick Sy Soda Mbaye Hawo Madina Diallo Audrey Samra Aboubacry Sadikh Sow Joseph Matar Mass Ndiaye Ousmane Ndiaga Senghor lamine Ndiaye mohamed Ndiaye Serigne Sohibou Gaye Papa Amadou Ndiaye Ophthalmology Department of Abass Ndao Hospital Dakar Senegal Ophthalmology Department of Aristide Le Dantec Hospital Dakar Senegal

Purpose: The aim is to show epidemiological, clinical and etiological characteristics of palpebral wounds. Methodology: This was a retrospective study focusing on patients with an eyelid wound, over a 10-year period from 2012 to 2021. We collected and analyzed the data using Excel. Results: The frequency of eyelid wounds was 0.1%. The average age of our patients was 19.38 years with a range of 1 and 62 years. The sex ratio was 3.7. Eighty-one percent of patients lived in Dakar. Fifty-seven percent (57%) of patients consulted less than 24 hours after the trauma and 7% of patients on D1. The circumstances were brawls (11%), domestic accidents (9%), road accidents (6%), and work accidents (6%). We noted 1 case of dog bite. Thirteen patients presented with post-traumatic decreased visual acuity. Involvement of the isolated upper eyelid was noted in 40% of cases and both eyelids in 15% of cases. Involvement of the lacrimal ducts was noted in 17% of cases, and that of the free edge in 21% of cases. Eyelid wounds were associated with eyeball damage in 21% of cases. Various associated lesions were observed. Ninety-one percent of patients received surgical treatment. Three cases of superinfections, 1 case of conjunctival granuloma and 1 case of phthysis of the eyeball with postoperative retinal detachment were noted. Conclusion: Eyelid sores are relatively common in our context. They require rapid surgical treatment in order to preserve the functional and aesthetic prognosis. .

关键词： Eyelid Wounds Epidemiology Clinic Etiologies

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