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The Reasons for Admission of elderly subjects in Intensive Care at the CHU Ignace Deen

Open Journal of Emergency Medicine 2023年第3期11卷 100-109页

作者： Abdoulaye Touré Amadou Yalla Camara Almamy Bangoura Donamou Joseph M’mah Lamine Camara Anesthesia-Resuscitation Service University Hospital of Ignace Deen of Conakry Conakry Guinea Medical and Surgical Emergency Department Donka University Hospital Conakry Guinea Anesthesia-Resuscitation Service Donka University Hospital Conakry Guinea

Objective: To determine the reasons for admission of elderly subjects and the prognosis in general intensive care. Patients and Methods: Observational descriptive and analytical study with prospective collection of data over a period of one year from January 1 to December 31, 2021. Patients aged 65 or over were included. Abstract: During the study period, 223 cases were collected out of 587 patients admitted, giving a prevalence of 37.9%. The average age was 74.127.39 ± years with extremes of 65 and 96 years and a male predominance (58.7%). The comorbidities were dominated by arterial hypertension (71.3%). The patients were: transferred from medical and surgical emergencies (75.8%). The average admission time was 48.8 ± 29.8 hours. One hundred and eight patients had a Glasgow score between 3 and 7. The reasons for admission were dominated by vascular causes (51.6%). Strokes of any type accounted for 43.9% of these reasons for admission. The average time for carrying out the biological assessments and imaging was 41.8 ± 27.3 hours with the extremes of 3 and 89 hours, 37.2% had a complete assessment within 24 hours. The average duration of hospitalization was 7.10 ± 8.87 days with extremes of 1 and 72 days. The mortality rate was 71.7%. Conclusion: This study has made it possible to take stock of the reasons for the admission of elderly subjects to intensive care. It appears that vascular causes are the main reasons for admission with heavy comorbidities which results in high mortality.

关键词： Reasons for Admission elderly subject Resuscitation

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Profile of Urinary Tract Infections in the elderly in the Internal Medicine Department of the University Hospital Center of Point G, Bamako, Mali

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Open Journal of Nephrology 2021年第2期11卷 217-229页

作者： Drissa Sangaré Magara Samaké Nanko Doumbia Aboubacar Sidiki Fofana Sékou Mamadou Cissé Seydou Sy Atabième Kodio Moctar Coulibaly Sah dit Baba Coulibaly Djibril Sy Kaya Assétou Soucko Mamadou Dembélé Saharé Fongoro Department of Medicine and Medical Specialty The Fousseyni Daou Hospital Kayes Mali Faculty of Medicine of Bamako Bamako Mali Nephrology Unit of Fousseyni Daou Hospital Kayes Mali Medicine Department of Mali Hospital Bamako Mali Nephrology Department of the University Hospital Center of Point G Bamako Mali Nephrology Unit of Mali Gavardo Hospital Bamako Mali Nephrology Unit of Somino Dolo Hospital Mopti Mali Internal Medicine Department of the University Hospital Center of Point G Bamako Mali

Introduction: Urinary tract infections (UTI) are frequent and of polymorphous clinical symptomatology in elderly subjects both in and out of hospital. In Mali, to our knowledge, no study concerning UTIs in the elderly has been conducted, hence the interest in this innovative work. Objectives: To determine the prevalence and clinical and paraclinical aspects of urinary tract infections in the elderly. Materials and Methods: This was a prospective descriptive and cross-sectional study from September 1, 2013 to August 31, 2014, i.e. duration of 12 months. All patients aged 65 years and over, hospitalized or ambulatory in the internal medicine department with a documented urinary tract infection were included. Results: We collected and examined 194 patients. The cytobacteriological study of urine (CBSU) was positive in 28 patients, i.e. a prevalence of 14.43%. The male sex represented 59.8% of the cases, the sex ratio was equal to 1.46. The age groups between 65 - 69 and 70 - 74 years were the most affected, respectively 28.57% and 39.28%. The main clinical signs were: asthenia, anorexia, dependence, fever, urinary burning, dysuria. Hospitalization was associated with urinary tract infection with P = 0.01. The group of enterobacteria were incriminated in 75% of cases. Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa represented 39.28%, 14.28% and 10.71% of cases. Urinary tract infections were represented by pyelonephritis, acute prostatitis, orchi-epididymitis and simple cystitis. Conclusion: Urinary tract infection is frequent in the elderly, its clinical presentation is polymorphic and enterobacteria are the most incriminated group of bacteria.

关键词： Urinary Tract Infection elderly subject Internal Medicine Point G Hospital Mali

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Continuous Spinal Anesthesia in Precarious Patients: An Experience in Lubumbashi DR Congo

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Open Journal of Anesthesiology 2023年第11期13卷 226-233页

作者： Wasso Milinganyo Eddy Timothée Dontaine Sagboze Zalambo Sandra Kibonge Mukakala Augustin Zirhumana Namegabe Franck Somwa Muhemedi Lucien Mukalay Banza Yves Tshisuz Nawej Christian Nguz A. Kutshid Nathan Kanyanda Nafatalewa Dimitri Ilunga Banza Mannix Mulewa Umba Deogracias Manika Muteya Michel Mbuyi Musanzayi Sébastien Arung Kalau Willy Iteke Fefe Karl-Rivain Department of Anesthesia and Critical Care University Clinics of Lubumbashi Lubumbashi DR Congo Department of Surgery Great Hospital of Charleroi Charleroi Belgium Department of Surgery University Clinics of Lubumbashi Lubumbashi DR Congo Department of Surgery Medicine School Official University of Bukavu Bukavu DR Congo Department of Anesthesia and Critical Care Diamant Medical Center Lubumbashi DR Congo

Background: Continuous spinal anesthesia (CSA) is an underused technique in modern anesthesia practice. Compared with other techniques of neuraxial anesthesia, CSA allows incremental dosing of an intrathecal local anesthetic for an indefinite duration, whereas traditional single-shot spinal anesthesia (SSA) usually involves larger doses, a finite, unpredictable duration, and greater potential for detrimental hemodynamic effects including hypotension, and epidural anesthesia via a catheter may produce lesser motor block and suboptimal anesthesia in sacral nerve root distributions. It is indicated in elderly patients undergoing lower limbs and sub umbilical surgery. Aim: This work aims to highlight the advantages of CSA on hemodynamic stability and as an alternative to heavy anesthetic procedures in already fragile patients. Case presentation: Our cases were two elderly patients, both of them with past stories of cardiac diseases. Both of them were undergoing amputation indicated for wet gangrene on lower limbs. They had unstable hemodynamics states due to inflammatory state. They were all rated ASA 3. CSA was performed with low doses of local anesthetics and maintenance by reinjections of mixture with the same doses. The interventions took place without major incidents and all patients survived. Conclusion: CSA is an underused technique in modern anesthesia. However, there is renewed interest due to the quality of the blocs and the hemodynamics stability. We report a case series of 2 elderly patients with past stories of cardiac diseases undergoing amputation for dry gangrene that had been operated under CSA.

关键词： Continuous Spinal Anesthesia (CSA) Precarious Patient Dry Gangrene elderly subject DR Congo

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Infectious Pneumonitis Revealing an Anal Imperforation with Recto-Vaginal Fistula: A Case of Late Discovery in a 70-Year-Old Woman

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Journal of Biosciences and Medicines 2023年第1期11卷 26-31页

作者： Sall Assane Bâ Massamba Diajhete Rokhaya Adja Awa Coumba Sarr Ba Dalahata Degboevi Vahana Toure Elsa Maimouna Coumé Mamadou Geriatrics Department Fann/Dakar University Hospital Dakar Senegal

Introduction: Anorectal malformations concern all anomalies of the terminal part of the digestive tract often diagnosed in the perinatal period. We report a clinical case of anorectal malformation discovered incidentally and very late at 70 years, following complications from the infectious syndrome. Observation: 70-year-old female patient, housewife, uneducated was referred to the hospital for acute febrile, cough, and mental confusion associated with chronic pelvic pain. The genito-anal examination showed an anal imperforation associated with a recto-vaginal fistula complicated by cervico-vaginitis. The evolution during hospitalization was favorable, but the patient died at home, 3 weeks after discharge. Conclusion: The discovery of anorectal malformation in adults is rare and exceptional in an elderly subject. This case demonstrates once again the challenges encountered in developing countries on the socio-economic and health levels.

关键词： Anorectal Malformation elderly subject Dakar Senegal

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