Introduction Over the past two decades, the incidence of acute rheumatic fever (ARF) and chronic rheumatic heart disease (RHD) have dramatically declined in wealthier regions of the world as a result ...of preventative programmes, improved living standards and access to cardiac surgery. Nevertheless, ARF and RHD are still public health problems in less-developed regions of the world such as Oceania, south Asia and sub-Saharan Africa.Aim We report on clinical, therapeutic and prognostic aspects as well as the difficulties encountered during this first series of surgery for rheumatic valve disease in Mali.Methods This was a prospective, descriptive study conducted at the Andre Festoc Cardiac Surgery Centre from September 2018 to August 2019.Results The frequency of patients having been operated on for rheumatic valve disease was 44.73% (68 patients). The mean age of the patients was 18 ± 10 years with extremes of five and 60 years. The gender ratio was 0.7. The delay to treatment was between one and three years for 39.7% of the patients. The main diagnoses found were: mitral regurgitation in 50% of patients, mitral stenosis in 16.2% and aortic regurgitation in 10.3%. Pulmonary artery systolic pressure was 35–50 mmHg in 19.1% of patients and more than 50 mmHg in 25%. The median cardiopulmonary bypass time was 132 minutes (60–276) and median extubation time was three hours (0–96). The main complications were cardiac, renal, neurological, respiratory, gastrointestinal and infectious. In the immediate postoperative period, we recorded three deaths, which is a mortality rate of 4.4%.Conclusion Humanitarian efforts have led non-governmental organisations (NGOs) to launch surgical programmes in low-and middle-income countries in an attempt to fill the gap in these fragile healthcare systems. Cardiac surgery requires much expertise from the medical staff, as well as many material and financial resources. Empowerment of the local team is a challenge that is being realised since taking these essential steps of companionship with the NGO la Chaine de l’Espoir.
The pseudocyst of the pancreas is rarely diagnosed and treated in our hospital, we report this first case of a 10-year-old child with no particular medical-surgical history with a history of impact ...trauma from the handlebars of his bicycle during a walk in the village. A week later, progressive abdominal pain appeared associated with an increase in the volume of the abdomen. A month after the trauma the signs of gastric and biliary compression settled type of nausea, postprandial vomiting, weight loss, anorexia, jaundice. After clinical, biological and radiological examinations, we retained the diagnosis of a pseudo cyst of the symptomatic pancreas. The treatment consisted in making an internal surgical bypass Kystogastric. Cytobacteriological examination of the collection of the contents of the pancreatic cyst revealed a multiresistant gram-negative bacterium «Achromobacter dentrificans», antibiotic therapy adapted to the germs was administered. The surgical suites were simple.
Objectives: To study delayed primary closure in ballistic and explosive device injuries by describing the clinical, therapeutic and evolutionary aspects. Methodology: This was a prospective study ...running from August 1, 2022 to May 31, 2023 including all patients of all ages presenting a ballistic or explosive device injury. Results: In 10 months, we collected 190 cases of ballistic and explosive device trauma, or 35.9%. The average age was 31.89 ± 14.026 years with a sex ratio of 12. Intercommunity conflicts were the most frequent causes (61.1%). Limb injuries represented 78.9 %, of which isolated wounds without fracture were the most frequent (59.5%). Standard radiography was ’the most used medical imaging (94%). DPC (Deferred Primary Closure) was performed in 71.2% followed by DPC + external fixator in 19%. We recorded 2 cases of death. Conclusion: Well-conducted delayed primary closure helps reduce the risk of complications, give the patient every chance of survival and shorten the hospital stay.
Objective: Study peritonitis by ileal perforation of typhic origin in children in the general surgery service of the Sominé Dolo hospital in Mopti. Method: It was a prospective study on children aged ...0 to 15 having been operated for peritonitis by ileal perforation of typhic origin produced at Sominé Dolo Hospital in Mopti over a period of 12 months going from January to December 2018. Results: We have identified 35 cases of ileal perforation of typhic origin which represented 22.3 % of all peritonitis (n = 157). The average age was 8.7 ± 3.5 years (extremes : 1 and 15 years). The sex ratio was 1.3. Most patients came from rural areas represented (74.3 %). The abdominal pain of progressive occurrence in 71.4 % of patients and generalized in 68.6 %. The average admission time was 10.7 ± 7.1 days (extremes: 2 and 30 days). Abdominal defense and abdominal contracture was found in 94.3 %. A pneumoperitoneum (31%), and a dislocated fluid effusion were found in 49% of patients. Excision-subsion in 54.3 % and ileostomy in 40 % were carried out. We have observed a morbidity rate at 48.6 % and 11 cases of death. Conclusion: Peritonitis by ileal perforation of typhic origin are frequent in our structure. The prognosis depends on the precocity of care despite mortality raised in developing countries.
Objectives: To study acute surgical abdomens by describing the clinical, paraclinical and therapeutic aspects. Methodology: This was a retrospective descriptive study from July 2019 to June 2021 ...including all patients taken in the surgical unit for acute surgical abdomens. Results: In 24 months, we collected 117 cases of acute surgical abdomens, or 19.1% of surgical interventions. The mean age was 30.6 ± 16.95 years. The sex ratio was 1.78. The reason for consultation was abdominal pain (100% of cases). The stopping of materials and gases represented 10.3% of cases. Intraperitoneal collection was the most common ultrasound sign found in 47.1% of cases. Acute appendicitis was the most frequent intraoperative diagnosis in 60.7% of cases. The surgical procedure performed was appendectomy (71.8%). The average length of hospitalization was four days. Morbidity was 6.8%. We recorded two deaths. Conclusion: Acute surgical abdomens occupy an important place in surgery due to their high frequency. The care is multidisciplinary.
Objective: To establish an assessment of surgical activities at the Tominian Reference Health Center. Method: This was a prospective descriptive study covering all patients received and operated on ...at the Tominian Reference Health Center over a period of 8 months from October 1, 2022 to May 2023; Results: We operated on 247 patients, including 64% (157 patients) in emergencies. The mean age was 35.6 ± 2.8 years with extremes of 2 and 57 years. Emergency cesarean section represented 49% (121 patients). Genital prolapse represented 13% (31 patients), hernias represented 11% (28 cases); acute peritonitis represented 5% (13 cases), intestinal obstruction 3% (7 cases). Benign prostatic hypertrophy (11 cases), uterine myomas (8 cases), uterine rupture (11 cases), splenectomy (2 cases), TAF (3 cases) and VVF (2 cases). We recorded 4 cases of death. Conclusion: Surgical pathologies remain frequent and diversified in rural areas, the need for qualified personnel in general and in surgical specialties in particular remains necessary to improve health coverage, especially for obstetric emergencies.
Nursing is an integral part of the health care system, providing support for people who are ill or in good health. It helps to provide comprehensive care for all users of care facilities. The overall ...aim is to help improve nursing practice in health care institutions. Methodology: we carried out a qualitative, quantitative and explanatory study using a field study in private and one public facilities involving 17 doctors and 25 nurses based on non-random sampling from 1er July to 31 August 2022 after obtaining informed consent. Results: The study revealed that 76% of nurses were unaware of the existence of their establishment's internal regulations and 60% were unaware of the description of their tasks in the department. Similarly, 25% of these nurses concluded that there was no reception procedure in their department. 72% of nurses stated that they did not have an identifier for their facility. While we found that only 4% of the nurses in our study had correctly defined the basis of nursing practice and the components of a nursing care plan, none of the nurses used a care plan in their department. As regards the doctor-nurse relationship within the care team, 29% of doctors treated nurses as subordinates. In conclusion, the problem of nursing care in Commune I is very real, and only strong administrative policies can improve it.
Urethral duplicity is a rare congenital malformation most commonly found in boys. Many anatomical forms have been described. The form associated with urethral stricture is a fairly rare combination. ...We report a case of hypospad urethral duplicity associated with bulbar urethral stricture. The patient was a 29-year-old male who presented with a double stream of urine associated with dysuria. On completion of the clinical and paraclinical examinations, we made the diagnosis of Effmann and Lebowitz type IB hypospade urethral duplicity associated with narrowing of the bulbar urethra. We proceeded to section the mucosal partition separating the 2 urethras from the meatus up to the bifurcation zone, followed by endoscopic internal uretrotomy of the stricture. Follow-up was straightforward and the result was deemed satisfactory after two years.
The aim of our study was to investigate antibiotic prophylaxis in the general surgery department of the C I commune referral health centre. This was a 12-month prospective study from 01 February 2021 ...to 31 January 2022 on antibiotic prophylaxis in general surgery. 129 patients were selected according to our inclusion criteria (patients who had received ceftriaxone at the time of anaesthetic induction. Patients belonging to Altemeier class I (clean surgery) with an infectious risk of estimated at 2 by the NNISS score and Altemeier class II (contaminated clean surgery). The antibiotic used was ceftriaz (ceftriaxone). The dose was two (2) grams. A single dose was given at the time of anaesthetic induction. The intravenous route was used exclusively. Patients underwent constant clinical monitoring. We had four (4) cases of surgical site infection (3.1%). The average post-operative hospital stay was two (2) days. Analysis of our results enabled us to identify a number of infectious risk factors: type of surgery, ASA score, emergency, anaemia and blood glucose level. Among the germs isolated, Escherichia coli was the most frequent (50%).
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