Rural Surgery in Niger: A Multicentric Study in 21 District Hospitals

The purpose of the study was to evaluate the qualitative aspect and global impact of surgery in a district hospital (DH) since the launching of the surgery at the district level. Surgical care was provided by general practitioners (GP) who received 12-month training in surgery, certified by a “Capacity of District Surgery” (CDS) diploma. It was a prospective study during 4 years from 2007 to 2010. Of the 34 DHs, only 21 were functional and included in this study. Most of the DHs had two or more CDS (n?=?15). The majority of the DHs had one nurse surgical aid (n?=?16) and one nurse anesthetist (n?=?17). The total number of surgical operations was 18,441 cases; emergency cases represented 51.8 % and elective surgery 48.2 %. Regarding emergency surgery, cesarean sections revealed the most common surgical procedure (37.21 %), followed by wound debridement (19.42 %). In elective surgery, hernia repair and hydrocelectomy were the most common surgical procedures (69.60 %), followed by gynecologic procedures in 12.74 % of the cases. The global complication rate was 4.34 %. The global mortality rate was 1.04 % (n?=?192), 102 deaths following cesarean section (2.87 %). No death was encountered in elective surgery. Nine hundred and fifty-five patients (5.17 %) were transferred to a higher-level facility of whom 598 patients (62.61 %) were admitted for fracture treatment. The concept of district surgery has proven to be an effective tool to counter skilled medical manpower shortage to perform emergency and elective basic surgery at the rural level and could be adopted by developing countries facing similar health challenges.     

Carbapenemases among Klebsiella pneumoniae: sensitivity, E-test and Hodge test

Carbapenems are the major weapons in the treatment of nosocomial infections. Since 1996, there have been an emergence and dissemination of carbapenem resistance in the world, especially among Enterobacteriaceae. Resistance is due to one or several mechanisms including production of carbapenemases. A prospective study was carried out from April to September 2011 at the Laboratory of Microbiology of Military Teaching Hospital in Rabat. The aim of this study was to search by phenotypic methods carbapenemases production in Klebsiella pneumoniae at Laboratory of Microbiology of the HMIMV of Rabat by disc diffusion for susceptibility to imipenem (IMP) and ertapenem (ETP), E-test and Hodge test; 211 strains of K. pneumoniae were analyzed. The samples were most frequently obtained from the urinary tract (63.8%); pus (16.5%) and blood cultures (11.8%);?27% of the strains produced extended spectrum of beta-lactamase (ESBL); 3 strains were resistant to ertapenem by disc diffusion. Investigations of these 3 strains in E-test shown that they were resistant to ertapenem but susceptible to imipenem. Tested by Hodge method, 3 strains gave repeatedly positive results. Thus, rate of K. pneumoniae producing KPC type in our study is 1.42%. Our study shows the evidence of K. pneumoniae type carbapenemase (KPC) in Military Teaching Hospital of Rabat. However, the gene encoding the type of resistance must be determined by molecular methods.     

联合P504s/P63检测应用于前列腺癌诊疗的价值

目的:探讨联合P504s/P63免疫组化对前列腺癌诊断准确度改善及其临床预后价值.方法:采用免疫组化对3个组(前列腺癌、上皮内瘤、良性前列腺增生)标本的P504s/P63表达进行检测并比较;评估前列腺癌诊断准确度,分析前列腺癌组P504s表达与3个临床预后因素(前列腺特异性抗原水平,Gleason评分及临床疾病分期)之...     

A fully automated chromatographic peak detection and treatment software for multi-user multi-task computers

A fully automated method is presented for the detection and integration of chromatographic peak software in which the only parameter to define is the data acquisition frequency; this has to be chosen high enough to minimize some Nyquist frequency problems. Programmed in C language, the software is used on a Unix like system (Xenix) to emphasize its automaticity. The performance of the system in liquid chromatography has been studied in respect of noise frequency and intensity. It is shown that the classical signal-to-noise ratio is obsolete for definition of the detection limit since frequency analysis allows some signal filtration; these limitations are described. An example is given of simulation with Gaussian peaks convoluted with noise characterized by its intensity and frequency distribution. The validity of the software is demonstrated for some HPLC separations.     

Protective effect of Moringa oleifera leaves against gentamicin-induced nephrotoxicity in rabbits

Oxidative stress due to abnormal production of reactive oxygen species has been implicated in the nephrotoxicity induced by gentamicin. The nephroprotective effect of aqueous-ethanolic extract of Moringa oleifera leaves (150 and 300 mg/kg) was evaluated against gentamicin-induced (80 mg/kg) renal injury in rabbits. Serum urea and creatinine levels were evaluated as the markers of renal nephrotoxicity. At the end of the experiment, the kidneys of rabbits were excised for histological examinations and determination of lipid peroxidation levels. Serum urea and creatinine levels were reduced in the M. oleifera (150 and 300 mg/kg) plus gentamicin treated groups. On histological examinations, kidney of intoxicated rabbits groups which received M. oleifera extract showed reparative tendencies. A highly significant (p < 0.01) elevation was observed in lipid peroxidation (LPO) level in the kidneys of gentamicin-intoxicated rabbits whereas combined treatment of M. oleifera and gentamicin group showed a highly significant (p < 0.01) depletion in LPO. The present study indicates that aqueous-ethanolic extract of M. oleifera leaves attenuates renal injury in rabbits treated with gentamicin, possibly by inhibiting lipid peroxidation.     

左旋布比卡因复合不同剂量舒芬太尼术后硬膜外自控镇痛临床对比研究

目的探讨和分析左旋布比卡因复合不同剂量舒芬太尼用于子宫切除术后硬膜外自控镇痛的临床效果、安全性及意义。方法收集拟行子宫切除术且ASAⅠ～Ⅱ级的患者135例,随机分为A、B和C组,各45例。三组术后均采用LCP模式镇痛,A组给予0.2%左旋布比卡因混合舒芬太尼0.4μg/mL;B组给予0.2%左旋布比卡因混合舒芬太尼0.6μg/mL;C组给予0.2%左旋布比卡因混合舒芬太尼0.8μg/mL。观察并记录各组患者镇痛泵开启前及开启后4、8、12及24 h的MAP、HR、视觉模拟法(VAS)评分、Ramsay评分、术后不良反应及并发症等情况。结果三组24 h舒芬太尼平均用量比较,差异均有统计学意义(均P<0.05);B组和C组镇痛效果于给药后8、12及24 h明显优于A组(P<0.05);B组和C组患者镇静效果于给药后12及24 h明显优于A组(P<0.05);与A组和B组相比C组患者出现恶心、呕吐及瘙痒等不良反应明显增多(P<0.05),B组和C组追加镇痛药患者显著少于A组(P<0.05)。结论经腹子宫切除术后硬膜外自控镇痛应用0.2%左旋布比卡因配伍舒芬太尼0.6μg/mL具有镇痛效果满意、安全性高和不良反应少等优点,值得临床推广。     

Emergence of SARS-CoV-2 Delta Variant,Benin, May–July 2021

Severe acute respiratory syndrome coronavirus 2 Delta variant epidemiology in Africa is unknown. We found Delta variant was introduced in Benin during April–May 2021 and became predominant within 2 months, after which a steep increase in reported coronavirus disease incidence occurred. Benin might require increased nonpharmaceutical interventions and vaccination coverage.     

After a decade of annual dose mass ivermectin treatment in Cameroon and Uganda, onchocerciasis transmission continues

Objective To evaluate the effectiveness of 10 years’ annual single dose ivermectin treatment on onchocerciasis transmission in hyperendemic areas of Cameroon and Uganda. Methods Baseline nodule and microfilaria (‘skin snip’) prevalence data were available from 10 hyperendemic sentinel communities in Cameroon (from 1996) and hyperendemic 20 sentinel communities in Uganda (from 1993). We returned to these villages in 2005, 10 months after the last annual ivermectin distribution, to repeat the cross‐sectional surveys. Each sentinel community reported a mean interval treatment coverage of eligible persons of >88% (range 37–100%). Data were analyzed for more than 6200 person examinations. In Cameroon, 719 people ≥10 years were examined at the baseline survey in 1996 and 838 at the follow‐up survey in 2005. In Uganda, 1590 people ≥10 years were examined at the baseline survey in 1993 and 2122 people at the follow‐up survey in 2005. We also examined children under 10 in Cameroon (1996, n = 185; 2005, n = 448) and Uganda (1993, n = 177; 2005, n = 130). In Uganda, the vitality of worms was judged using standard histological criteria in 80 nodules excised in 2005. Results The prevalence of microfilaria carriers among older children and adults (≥10 years) in Cameroon sentinel communities dropped from 70.1% to 7.04% (P < 0.0001) over the 10‐year treatment period; that of nodule carriers from 58% to 9.55% (P < 0.0001). Similarly, in Uganda, the prevalence of microfilaria carriers fell from 71.9% to 7.49% (P < 0.0001) over the 13‐year treatment period, and that of nodule carriers from 53.21% to 9.66% (P < 0.0001). The number of microfilaria carriers among children <10 years in Cameroon decreased from 29.73% to 3.8% (P < 0.0001), and in Uganda from 33.89% to 3.1% (P < 0.0001). In 2005, worms excised from nodules in Uganda, 81.4% of males remained alive, and 64% of females, with 24% of them inseminated. Conclusion A decade or more of annual single dose ivermectin treatment in hyperendemic areas has reduced onchocerciasis to ‘hypoendemicity’, but onchocerciasis transmission persists. For now, annual treatment with ivermectin should be continued in formerly mesoendemic and hyperendemic zones.