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surgical Site Infections in Trauma and Orthopaedics at Bouaké teaching hospital (Côte d’Ivoire)

Open Journal of Orthopedics 2024年第9期14卷 381-390页

作者： Loukou Blaise Yao Koffi Léopold Krah Aya Adelaïde Natacha Kouassi Kouamé Innocent M’bra Kouamé Jean-Eric Kouassi Michel Kodo Department of Trauma and Orthopaedics Bouak Teaching Hospital Bouak Cte dIvoire

Background: surgical site infections are serious healthcare problems. The aim was to describe the epidemiological, diagnostic, therapeutic, and prognostic aspects of surgical site infections in Trauma and Orthopaedics at Bouaké teaching hospital. Method: This retrospective, descriptive, and analytical study was conducted from January 2019 to December 31, 2021. The data studied included prevalence, initial lesions, type of surgical intervention, type of SSI, bacteria involved, treatment, and outcomes. Results: Forty-four (11%) of the 399 patients included in the study developed a surgical site infection. The mean age was 27 years, with 36 male and 8 female. Initial lesions were predominantly open fractures (n = 31;70%), with a mean delay of 48 hours for surgical management. Emergency interventions accounted for 70% (n = 31) of cases. The NNISS infection risk score was 1 in 80% (n = 35) of cases. Superficial infections (n = 34;77%) appeared early, on a mean 6 days postoperatively. Bacteriological analysis primarily identified Pseudomonas aeruginosa (n = 10;23%), sensitive to Imipenem and Chloramphenicol but resistant to Amoxicillin-clavulanic acid, Ceftriaxone, Gentamicin, and Ciprofloxacin. Multidrug-resistant bacteria were found in 89% (n = 8) of cases, with all bacteria resistant to Ceftriaxone. surgical revision was performed in 10 patients (23%), primarily involving debridement with hardware retention (n = 7;70%). Chloramphenicol was the most commonly used antibiotic post-antibiogram (61%). Outcomes were favourable in 98% of cases. Identified risk factors included the type of lesion according to NRC classification, the delay in managing open fractures, and the NNISS score. Conclusion: The prevalence of surgical site infection was 11%, favoured by the delayed operation of open fractures.

关键词： surgical Site Infection Open Fractures Pseudomonas aeruginosa Ceftriaxone

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Skin and Soft Tissue Infections in the surgical Area at the Kara teaching hospital

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surgical Science 2024年第2期15卷 48-53页

作者： Tamegnon Dossouvi Tchaa Hodabalo Towoezim Efoé-Ga Olivier Amouzou Kokou Kouliwa Kanassoua Irokoura Kassagne Ayi Amavi Abossisso Sakiye Komlan Adabra Ekoué David Dosseh Department of General Surgery Dapaong Regional Hospital Center Dapaong Togo Department of Orthopedic and Traumatology Kara Teaching Hospital Kara Togo Department of General Surgery Kara Regional Hospital Center Kara Togo Department of General Surgery Sylvanus Olympio University Hospital Lomé Togo

Objective: To report the management of skin and soft tissue infections in the surgical area of Kara University hospital in Togo. Material and Methods: This study was conducted retrospectively from January 1, 2021, to December 31, 2022, in the general surgery and orthopedic trauma departments. The study focused on soft tissue infections of the pelvic and thoracic limbs and analyzed epidemiological, clinical, paraclinical, therapeutic, and evolutionary data. Results: We registered 165 patients, comprising 109 men and 56 *** sex ratio (F/H) were 0.51. The mean age was 45 years with extremes ranging from 23 to 90 years. Farmers (64.8%) followed by housewives (34.0%) were the social strata most affected. The consultation period varied between 1 and 90 days. The pathologies found were necrotizing fasciitis (53.3%), erysipelas (18.2%), infected limb wounds (12.1%), pyomyositis (9.7%), and necrotizing dermo-hypodermitis (1.8%). The main procedures performed were necrosectomy and grafting (62.9%), sample necrosectomy (18.8%), drainage (9.7%), and pelvic limb amputation (1.2%). Follow-up was favorable in 86.7% of cases. The study noted a death rate of 13.3% due to septic shock secondary to a delay in consultation. Conclusion: Skin and soft tissue infections were a common reason for surgical hospitalization at Kara University hospital, with a high mortality rate due to delayed consultations.

关键词： Skin and Soft Tissue Infections Necrotizing Fasciitis Erysipelas Emergency

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Comparison of the Outcome of Treatment of Chronic Osteomyelitis by surgical Debridement with and without Local Antibiotic Delivery System: Experience from a Nigerian teaching hospital

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International Journal of Clinical Medicine 2013年第7期4卷 313-318页

作者： Ikpeme A. Ikpeme Enembe O. Oku Ngim E. Ngim Iniabasi U. Ilori Innocent E. Abang Department of Anaesthesiology University of Calabar Teaching Hospital Calabar Nigeria. Department of Com- munity Medicine University of Calabar Teaching Hospital Calabar Nigeria Department of Orthopaedics and Traumatology University of Calabar Teaching Hospital Calabar Nigeria

Background: Chronic osteomyelitis is still common in the developing world and presents a continuing therapeutic challenge. Antibiotics cannot penetrate the dense fibrotic scar tissue that surrounds infected and avascular bone which perpetuates the infection. surgical debridement/sequestrectomy is the cornerstone to treatment and aims to create a viable, vascularized base which promotes healing. surgical debridement necessarily creates a dead space which must be dealt with to prevent re-infection. Local antibiotic delivery systems serve the dual purpose of obliterating dead space and creating a sterile local environment with high bactericidal concentrations. Aim: To determine the outcomes in patients with chronic osteomyelitis who received debridement/sequestrectomy alone, and those who received the procedure combined with a local antibiotic delivery system in the University of Calabar teaching hospital. Patients and Methods: A prospective descriptive analysis of patients managed surgically for chronic osteomyelitis from July 2007 to December, 2012. Patients’ biodata, aetiology, organisms, treatment options and outcomes were analysed. Results: Forty-four patients presented with the condition and accepted surgery. Male:Female ratio was 2.1:1, and mean age was 27.27 ± 17.48 years. The tibia was the most commonly affected bone (45.5%), Staphylococcus aureus was the commonest organism (56.8% of sinus cultures;73% of marrow/sequestral cultures) and previous acute haematogenous osteomyelitis was the commonest mechanism. The use of a local antibiotic delivery system improved cure rates from 57.7% to 77.8%). Conclusion: Multiple surgical interventions increase the socioeconomic costs of treating this condition and have a direct impact on the economies of individuals especially in the developing world. surgical interventions should aim at achieving maximum impact with minimum repetition of the processes. Adequate surgical debridement combined with a local antibiotic delivery

关键词： Chronic Osteomyelitis Debridement/Sequestrectomy Local Antibiotic Systems Outcomes

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surgical Activities in the Gynecology-Obstetrics Department of the teaching hospital Yalgado-Ouédraogo of Ouagadougou: Assessment of One Year of Practice from January 1<sup>st</sup>, 2015 to December 31<sup>st</sup>, 2015

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Open Journal of Obstetrics and Gynecology 2018年第14期8卷 1501-1509页

作者： Dantola Paul Kain Issa Ouédraogo Yobi Alexis Sawadogo Evelyne Komboigo Sibraogo Kiemtoré Adama Ouattara Hyacinthe Zamané Blandine Thiéba Department of Obstetrics and Gynecology Yalgado Ouedraogo Teaching Hospital in Ouagadougou Ouagadougou Burkina Faso Department of Obstetrics and Gynecology Teaching Hospital in Ouahigouya Ouahigouya Burkina Faso

Objective: The objective of our study was to study the surgical activities carried out in the gynecology-obstetrics department of the CHU-YO (teaching hospital Yalgado Ouédraogo) from January 1st 2015 to December 31st, 2015. Patients and Methods: This dealt with a cross-cutting descriptive and analytic study with retrospective data collection. Our study has included the female patients who underwent surgery in the operating room and whose medical records were usable. Results: 45% of female patients admitted in the concerned department underwent a surgery. The average age of patients was estimated at 28.02 years ±7 years with extremes of 13 years and 80 years. Obstetrical surgery has involved 89.9% of cases. Female patients have received a loco-regional anesthesia in 92.7% of cases. Emergency surgical operations accounted for 88.8% and caesarean section was the main surgical operation carried out in 87.1% of cases. The mortality rate of the overall surgical operations was 1.04%. Conclusion: A better availability of labile blood products is more likely to reduce the mortality rate of surgical operations under the threshold of 1%.

关键词： Surgery Caesarean Section Prognosis Mortality Rate

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Laparoscopic right radical hemicolectomy: Central vascular ligation and complete mesocolon excision vs D3 lymphadenectomy - How I do it?

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World Journal of Gastrointestinal Surgery 2024年第6期16卷 1521-1526页

作者： Kaushal Yadav Department of surgical Oncology Max HospitalGurugram 122001HaryanaIndia

In colon cancer surgery,ensuring the complete removal of the primary tumor and draining lymph nodes is *** drainage in the colon follows the vascular supply,typically progressing from pericolic to paraaortic lymph *** NCCN guidelines recommend the removal of 10-12 lymph nodes for ade-quate oncological resection,achieving complete oncological resection involves more than just meeting these numerical *** techniques have been developed and studied over time to attain optimal oncological outcomes.A key technique central to this goal is identifying the ileocolic vessels at their origin from the superior mesenteric *** excision of the visceral and parietal mesocolon ensures the intact removal of the specimen,while D3 lymphade-nectomy targets all draining regional lymph *** these principles emphasize different aspects,they ultimately converge to achieve the same goal of complete oncological *** article aims to simplify the surgical steps that align with the principle of central vascular ligation and mesocolon mobilization while ensuring adequate D3 dissection.

关键词： Carcinoma caecum Carcinoma ascending colon Right hemicolectomy Extended right hemicolectomy Central vascular ligation Complete mesocolon excision D3 lymphadenectomy Laparoscopic right hemicolectomy Minimally invasive hemico-lectomy

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Diagnosis and management of malaria in the intensive care unit

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Journal of Intensive Medicine 2024年第1期4卷 3-15页

作者： George Akafity Nicholas Kumi Joyce Ashong Department of Research Monitoringand EvaluationCape Coast Teaching HospitalCape CoastGhana Intensive Care Unit Department of Critical Care and AnesthesiaCape Coast Teaching HospitalCape Coast Department of Paediatrics and Child Health Cape Coast Teaching HospitalCape CoastGhana

Malaria is responsible for approximately three-quarters of a million deaths in humans globally each *** of the morbidity and mortality reported are from Sub-Saharan Africa and Asia,where the disease is *** non-endemic areas,malaria is the most common cause of imported infection and is associated with significant mortality despite recent advancements and investments in elimination *** malaria often requires intensive care unit admission and can be complicated by cerebral malaria,respiratory distress,acute kidney injury,bleeding complications,and *** care management includes prompt diagnosis and early initiation of effective antimalarial therapy,recognition of complications,and appropriate supportive ***,the lack of diagnostic capacities due to limited advances in equipment,personnel,and infrastructure presents a challenge to the effective diagnosis and management of *** article reviews the clinical classification,diagnosis,and management of malaria as relevant to critical care clinicians,highlighting the role of diagnostic capacity,treatment options,and supportive care.

关键词： Malaria Intensive care unit Severe malaria Antimicrobial resistance Antimalarials Artemisinin-based combination therapy

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Acute Intestinal Invagination of the Child at the teaching hospital of Bouaké: Ultrasound Diagnosis and Clinical-Echo-surgical Correlation

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Open Journal of Medical Imaging 2021年第1期11卷 18-28页

作者： Bouassa Davy Melaine Kouakou Konaté Issa Kouamé Paul Bonfils Kouassi Adoubs Cé lestin Bé nié Tsri Akoli Baudouin Bravo Kesse Emile Tanoh Allou Florent Kouadio Brou Lambert Yao Achie Jean-Ré gis Akobe Sara Carole Sanogo Malick Soro Kouadio N’Dri Medical Imaging and Radiodiagnostic Departement of the teaching hospital of Bouaké Bouak&#233 Ivory Coast Training and Research Unit Medical Sciences Alassane Ouattara University Bouak&#233 Ivory Coast Pediatric Surgery Unit of the teaching hospital of Bouaké Bouak&#233 Ivory Coast

Background: Acute intestinal invagination or intussusception is the most common abdominal surgical emergency in infants, but it can occur at any age. Performing an ultrasound scan at the slightest clinical suspicion contributes to early diagnosis and therapeutic management. Objective: To show the relevance of ultrasound in the therapeutic management of the child’s intussusception through a correlation between the ultrasound diagnosis and the clinical and/or per operative diagnosis. Patients and Methods: It was a retrospective study of 24 cases from July 2017 to September 2020 (30 months) in the Medical Imaging and Paediatric Surgery departments of teaching hospital of Bouaké. We included only patients from 0 to 15 years old who had digestive symptoms, an abdominal ultrasound scan. These patients were eligible for surgery. Data analysis was performed with Epi info 7 software. Results: Median age was 17.2 months [02 - 120]. Male gender predominated (83.3%). Clinico-biological data were dominated by abdominal pain (79.2%), vomiting (75%) and rectorragies (33.3%), with Ombredanne’s triad in 33.3% and hyperleukocytosis (70.8%). Ultrasonography showed invaginated coves (95.8%) sitting in the right angl iliac fossa, peri-umbilical and right flank in 73.9%. Cockade image coupled with the sandwich image accounted for 95.6%. Superficial adenopathies (45.8%) and peri-lesional fluid effusion (20.8%) were associated with it. An occlusive syndrome complicating intussusception was observed in 41.67% associated with intra-peritoneal effusion of fluid (25%). There was a significant diagnostic agreement between the clinic, ultrasound and surgery according to the Fisher’s exact test (p = 0.002). That between ultrasound and surgery was calculated at 95.4%. Conclusion: This study allowed us to show a good clinical-echo-surgical concordance. Ultrasound is therefore an undeniable diagnostic, prognostic an

关键词： Ultrasound Acute Intestinal Invagination Child

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Is tumor necrosis factor-α monoclonal therapy with proactive therapeutic drug monitoring optimized for inflammatory bowel disease? Network meta-analysis

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World Journal of Gastrointestinal Surgery 2024年第2期16卷 571-584页

作者： Fang-Yuan Zheng Kai-Si Yang Wen-Cheng Min Xin-Zhu Li Yu Xing Shuai Wang Ying-Shi Zhang Qing-Chun Zhao teaching hospital of Shenyang Pharmaceutical University General Hospital of Northern Theater CommandShenyang 110016Liaoning ProvinceChina

BACKGROUND The efficacy and safety of anti-tumor necrosis factor-α(TNF-α)monoclonal antibody therapy[adalimumab(ADA)and infliximab(IFX)]with therapeutic drug monitoring(TDM),which has been proposed for inflammatory bowel disease(IBD)patients,are still *** To determine the efficacy and safety of anti-TNF-αmonoclonal antibody therapy with proactive TDM in patients with IBD and to determine which subtype of IBD patients is most suitable for proactive TDM *** As of July 2023,we searched for randomized controlled trials(RCTs)and observa-tional studies in PubMed,Embase,and the Cochrane Library to compare anti-TNF-αmonoclonal antibody therapy with proactive TDM with therapy with reactive TDM or empiric *** and network meta-analyses were used to determine the IBD patient subtype that achieved clinical remission and to determine the need for *** This systematic review and meta-analysis yielded 13 studies after exclusion,and the baseline indicators were *** found a significant increase in the number of patients who achieved clinical remission in the ADA[odds ratio(OR)=1.416,95%confidence interval(CI):1.196-1.676]and RCT(OR=1.393,95%CI:1.182-1.641)subgroups and a significant decrease in the number of patients who needed surgery in the proactive vs reactive(OR=0.237,95%CI:0.101-0.558)and IFX+ADA(OR=0.137,95%CI:0.032-0.588)subgroups,and the overall risk of adverse events was reduced(OR=0.579,95%CI:0.391-0.858)according to the pairwise ***,the network meta-analysis results suggested that patients with IBD treated with ADA(OR=1.39,95%CI:1.19-1.63)were more likely to undergo TDM,especially in comparison with patients with reactive TDM(OR=1.38,95%CI:1.07-1.77).CONCLUSION Proactive TDM is more suitable for IBD patients treated with ADA and has obvious advantages over reactive *** recommend proactive TDM in IBD patients who are treated with ADA.

关键词： Inflammatory bowel disease Therapeutic drug monitoring Adalimumab Infliximab Network meta-analysis

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Optimized sequential therapy vs 10- and 14-d concomitant therapy for eradicating Helicobacter pylori: A randomized clinical trial

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World Journal of Gastroenterology 2024年第6期30卷 556-564页

作者： Hassan Seddik Jihane Benass Sanaa Berrag Asmae Sair Reda Berraida Hanae Boutallaka Department of Gastroenterology II Mohammed V Military Teaching Hospital of RabatRabat 10100Morocco Department of Gastroenterology Mohammed V University in RabatRabat 10100Morocco Department of Gastroenterology I Mohammed V Military Teaching Hospital of RabatRabat 10100Morocco

BACKGROUND A cure for Helicobacter pylori(***)remains a problem of global *** prevalence of antimicrobial resistance is widely rising and becoming a challenging issue *** sequential therapy seems to be one of the most attractive strategies in terms of efficacy,tolerability and *** most common sequential therapy consists of a dual therapy[proton-pump inhibitors(PPIs)and amoxicillin]for the first period(5 to 7 d),followed by a triple therapy for the second period(PPI,clarithromycin and metronidazole).PPIs play a key role in maintaining a gastric pH at a level that allows an optimal efficacy of antibiotics,hence the idea of using new generation *** open-label prospective study randomized 328 patients with confirmed *** infection into three groups(1:1:1):The first group received quadruple therapy consisting of twice-daily(bid)omeprazole 20 mg,amoxicillin 1 g,clarith-romycin 500 mg and metronidazole 500 mg for 10 d(QT-10),the second group received a 14 d quadruple therapy following the same regimen(QT-14),and the third group received an optimized sequential therapy consisting of bid rabe-prazole 20 mg plus amoxicillin 1 g for 7 d,followed by bid rabeprazole 20 mg,clarithromycin 500 mg and metronidazole 500 mg for the next 7 d(OST-14).AEs were recorded throughout the study,and the *** eradication rate was determined 4 to 6 wk after the end of treatment,using the 13C urea breath *** In the intention-to-treat and per-protocol analysis,the eradication rate was higher in the OST-14 group compared to the QT-10 group:(93.5%,85.5%P=0.04)and(96.2%,89.5%P=0.03)***,there was no statist-ically significant difference in eradication rates between the OST-14 and QT-14 groups:(93.5%,91.8%P=0.34)and(96.2%,94.4%P=0.35),*** overall incidence of AEs was significantly lower in the OST-14 group(P=0.01).Furthermore,OST-14 was the most cost-effective among the three *** The optimized 14-

关键词： Helicobacter pylori Quadruple therapy Sequential Proton-pump inhibitor Optimization

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Liver transplantation as an alternative for the treatment of non-resectable liver colorectal cancer: Advancing the therapeutic algorithm

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Hepatobiliary & Pancreatic Diseases International 2024年第2期23卷 154-159页

作者： Badi Rawashdeh Richard Bell Abdul Hakeem Raj Prasad Division of Transplant Surgery Department of General SurgeryMedical College of WisconsinMilwaukeeWI53226USA Leeds teaching hospital LeedsUK

Colorectal cancer is a leading cause of cancerrelated mortality,with nearly half of the affected patients developing liver *** three decades,liver resection(LR)has been the primary curative strategy,yet its applicability is limited to about 20%of *** transplantation(LT)for unresectable metastases was attempted unsuccessfully in the 1990s,with high rates of perioperative death and *** is now more interest in this strategy due to improvements in systemic therapies and surgical techniques.A significant study conducted by the Oslo group showed that patients receiving liver transplants had a 60%chance of survival after five *** better results have been achieved by using advanced imaging for risk stratification and further refining selection criteria,especially in the Norvegian SECA *** review carefully charts the development and history of LT as a treatment option for colorectal cancer liver *** revolutionary path from the early days of exploratory surgery to the current situation of cautious optimism is traced,highlighting the critical clinical developments and improved patient selection standards that have made LT a potentially curative treatment for such challenging very well selected cases.

关键词： Liver transplantation Colorectal cancer liver metastases Non-resectable liver metastases

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