The onset of a major seagrass initiative in West Africa enabled important seagrass discoveries in several countries, in one of the least documented seagrass regions in the world. Four seagrass ...species occur in western Africa, Cymodocea nodosa, Halodule wrightii, Ruppia maritima and Zostera noltei. An area of about 62,108 ha of seagrasses was documented in the studied region comprising seven countries: Mauritania, Senegal, The Gambia, Guinea Bissau, Guinea, Sierra Leone and Cabo Verde. Extensive meadows of Zostera noltei were recorded for the first time at Saloum Delta, Senegal, which represents the new southernmost distribution limit of this species. This paper also describes the seagrass morphology for some study areas and explores the main stressors to seagrasses as well as conservation initiatives to protect these newly documented meadows in West Africa. The produced information and maps serve as a starting point for researchers and managers to monitor temporal and spatial changes in the meadows’ extent, health and condition as an efficient management tool.
L'anesthésie des personnes âgées de 65 ans et plus en urgence reste complexe. La survenue d'incidents peropératoires et en l'occurrence l'hypotension artérielle est conditionnée par leur état de ...santé initial et par la qualité de la prise en charge péri-opératoire. L'étude a pour but de déterminer l'incidence de l'hypotension artérielle per-anesthésique du sujet âgé pour une chirurgie urgente et évaluer l'implication de certains facteurs dans sa survenue: âge, sexe, terrain, classe ASA, technique anesthésique. Une étude rétrospective descriptive et analytique a été réalisée aux blocs des urgences chirurgicales du CHU Aristide LE DANTEC allant du 1er mars 2014 au 28 février 2015. Nous avons colligé 210 patients sur 224 anesthésies en urgence du sujet âgé de 65 ans et plus, soit 10,93%. On notait 101 hommes et 109 femmes dont les 64,3% présentaient au moins une tare. L'évaluation de l'état préopératoire des patients a été faite avec la classification de l'American Society of Anesthesiology (ASA), avec 71% pour les classes ASA 1 et 2 et 29% pour les classes ASA 3 et 4. L'anesthésie locorégionale était la technique anesthésique la plus pratiquée (56,7%). L'hypotension artérielle peropératoire a été objectivée chez 28 patients soit 13,33%, dont 16 cas sous anesthésie générale et 12 cas sous anesthésie locorégionale. Elle était plus fréquente chez les patients de classe ASA élevée et un peu moins sur terrain d'HTA et de cardiopathie sous-jacente. L'anesthésie du sujet âgé en urgence expose à un risque d'hypotension artérielle peropératoire non négligeable notamment chez les patients de classes ASA élevée. Sa prévention repose sur une bonne évaluation préopératoire et une prise en charge anesthésique adéquate.
La prise en charge périopératoire des urgences chirurgicales abdominales reste une préoccupation majeure des anesthésistes du fait des désordres hémodynamiques et/ou métaboliques souvent présents en ...préopératoire; mais également des complications postopératoires auxquelles elles sont exposées. Les objectifs de ce travail étaient d'étudier les aspects épidémiologiques, diagnostiques, thérapeutiques et pronostiques des urgences abdominales. Etude rétrospective descriptive sur une période de 6 mois portant sur les patients âgés de plus de 16 ans opérés d'une urgence abdominale à l'hôpital Aristide Le Dantec. Les paramètres étudiés portaient sur les aspects épidémiologiques, diagnostiques, thérapeutiques et pronostiques des urgences chirurgicales abdominales. Nous avions colligé 161 cas, près de 20% de l'activité du service. L'âge moyen était de 41 ans 16, 80 ans. Le sex ratio était de 2, 9. Le délai moyen de consultation était de 4,6 jours. Les péritonites étaient les pathologies les plus fréquentes (25,5%). La fréquence cardiaque moyenne des patients était de 92 bpm (battements/min)et 97 bpm pour ceux ayant eu une préparation hémodynamique préopératoire. La moyenne de la PAM était de 9,66 cmhg et 8,61 cmhg chez les patients préparés. 49,1% des patients étaient de la classe ASA1, 39,9% ASA2, 8,7% ASA3, 2,5% ASA4 et 0,6% ASA5. Une antibioprophylaxie était faite chez 46,30% des patients et 53,41% d'entre eux avaient eu une antibiothérapie.95,6% des patients avaient eu une anesthésie générale et 4,4% une rachianesthésie. La fréquence des incidents peropératoires était de 11,08%. La morbidité était de 4,3% et la mortalité 4,96%. La prise en charge des urgences chirurgicales abdominales doit être multidisciplinaire impliquant anesthésistes, chirurgiens et biologistes afin de réduire davantage le taux de morbimortalité qui reste de nos jours non négligeable.
Maximising patient comfort during and after surgery is a primary concern of anaesthetists and other perioperative clinicians, but objective measures of what constitutes patient comfort in the ...perioperative period remain poorly defined. The Standardised Endpoints in Perioperative Medicine initiative was established to derive a set of standardised endpoints for use in perioperative clinical trials.
We undertook a systematic review to identify measures of patient comfort used in the anaesthetic, surgical, and other perioperative literature. A multi-round Delphi consensus process that included up to 89 clinician researchers was then used to refine a recommended list of outcome measures.
We identified 122 studies in a literature search, which were the basis for a preliminary list of 24 outcome measures and their definitions. The response rates for Delphi Rounds 1, 2, and 3 were 100% (n=22), 90% (n=79), and 100% (n=13), respectively. A final list of six defined endpoints was identified: pain intensity (at rest and during movement) at 24 h postoperatively, nausea and vomiting (0–6 h, 6–24 h, and overall), one of two quality-of-recovery (QoR) scales (QoR score or QoR-15), time to gastrointestinal recovery, time to mobilisation, and sleep quality.
As standardised outcomes will support benchmarking and pooling (meta-analysis) of trials, one or more of these recommended endpoints should be considered for inclusion in clinical trials assessing patient comfort and pain after surgery.
Adverse cardiovascular events are a leading cause of perioperative morbidity and mortality. The definitions of perioperative cardiovascular adverse events are heterogeneous. As part of the ...international Standardized Endpoints in Perioperative Medicine initiative, this study aimed to find consensus amongst clinical trialists on a set of standardised and valid cardiovascular outcomes for use in future perioperative clinical trials.
We identified currently used perioperative cardiovascular outcomes by a systematic review of the anaesthesia and perioperative medicine literature (PubMed/Ovid, Embase, and Cochrane Library). We performed a three-stage Delphi consensus-gaining process that involved 55 clinician researchers worldwide. Cardiovascular outcomes were first shortlisted and the most suitable definitions determined. These cardiovascular outcomes were then assessed for validity, reliability, feasibility, and clarity.
We identified 18 cardiovascular outcomes. Participation in the three Delphi rounds was 100% (n=19), 71% (n=55), and 89% (n=17), respectively. A final list of nine cardiovascular outcomes was elicited from the consensus: myocardial infarction, myocardial injury, cardiovascular death, non-fatal cardiac arrest, coronary revascularisation, major adverse cardiac events, pulmonary embolism, deep vein thrombosis, and atrial fibrillation. These nine cardiovascular outcomes were rated by the majority of experts as valid, reliable, feasible, and clearly defined.
These nine consensus cardiovascular outcomes can be confidently used as endpoints in clinical trials designed to evaluate perioperative interventions with the goal of improving perioperative outcomes.
Clinical indicators are powerful tools to quantify the safety and quality of patient care. Their validity is often unclear and definitions extremely heterogeneous. As part of the International ...Standardised Endpoints in Perioperative Medicine (StEP) initiative, this study aimed to derive a set of standardised and valid clinical outcome indicators for use in perioperative clinical trials.
We identified clinical indicators via a systematic review of the anaesthesia and perioperative medicine literature (PubMed/OVID, EMBASE, and Cochrane Library). We performed a three-stage Delphi consensus-gaining process that involved 54 clinician–researchers worldwide. Indicators were first shortlisted and the most suitable definitions for evaluation of quality and safety interventions determined. Indicators were then assessed for validity, reliability, feasibility, and clarity.
We identified 167 clinical outcome indicators. Participation in the three Delphi rounds was 100% (n=13), 68% (n=54), and 85% (n= 6), respectively. A final list of eight outcome indicators was generated: surgical site infection at 30 days, stroke within 30 days of surgery, death within 30 days of coronary artery bypass grafting, death within 30 days of surgery, admission to the intensive care unit within 14 days of surgery, readmission to hospital within 30 days of surgery, and length of hospital stay (with or without in-hospital mortality). They were rated by the majority of experts as valid, reliable, easy to use, and clearly defined.
These clinical indicators can be confidently used as endpoints in clinical trials measuring quality, safety, and improvement in perioperative care.
PROSPERO 2016 CRD42016042102 (http://www.crd.york.ac.uk/PROSPERO/display_record.php? ID=CRD42016042102).
Perioperative infection and sepsis are of fundamental concern to perioperative clinicians. However, standardised endpoints are either poorly defined or not routinely implemented. The Standardised ...Endpoints in Perioperative Medicine (StEP) initiative was established to derive a set of standardised endpoints for use in perioperative clinical trials.
We undertook a systematic review to identify measures of infection and sepsis used in the perioperative literature. A multi-round Delphi consensus process that included more than 60 clinician researchers was then used to refine a recommended list of outcome measures.
A literature search yielded 1857 titles of which 255 met inclusion criteria for endpoint extraction. A long list of endpoints, with definitions and timescales, was generated and those potentially relevant to infection and sepsis circulated to the theme subgroup and then the wider StEP-COMPAC working group, undergoing a three-stage Delphi process. The response rates for Delphi rounds 1, 3, and 3 were 89% (n=8), 67% (n=62), and 80% (n=8), respectively. A set of 13 endpoints including fever, surgical site, and organ-specific infections as defined by the US Centres for Disease Control and Sepsis-3 are proposed for future use.
We defined a consensus list of standardised endpoints related to infection and sepsis for perioperative trials using an established and rigorous approach. Each endpoint was evaluated with respect to validity, reliability, feasibility, and patient centredness. One or more of these should be considered for inclusion in future perioperative clinical trials assessing infection, sepsis, or both, thereby permitting synthesis and comparison of future results.
Mortality, morbidity, and organ failure are important and common serious harms after surgery. However, there are many candidate measures to describe these outcome domains. Definitions of these ...measures are highly variable, and validity is often unclear. As part of the International Standardised Endpoints in Perioperative Medicine (StEP) initiative, this study aimed to derive a set of standardised and valid measures of mortality, morbidity, and organ failure for use in perioperative clinical trials.
Three domains of endpoints (mortality, morbidity, and organ failure) were explored through systematic literature review and a three-stage Delphi consensus process using methods consistently applied across the StEP initiative. Reliability, feasibility, and patient-centredness were assessed in round 3 of the consensus process.
A high level of consensus was achieved for two mortality time points, 30-day and 1-yr mortality, and these two measures are recommended. No organ failure endpoints achieved threshold criteria for consensus recommendation. The Clavien–Dindo classification of complications achieved threshold criteria for consensus in round 2 of the Delphi process but did not achieve the threshold criteria in round 3 where it scored equivalently to the Post Operative Morbidity Survey. Clavien–Dindo therefore received conditional endorsement as the most widely used measure. No composite measures of organ failure achieved an acceptable level of consensus.
Both 30-day and 1-yr mortality measures are recommended. No measure is recommended for organ failure. One measure (Clavien–Dindo) is conditionally endorsed for postoperative morbidity, but our findings suggest that no single endpoint offers a reliable and valid measure to describe perioperative morbidity that is not dependent on the quality of deli-vered care. Further refinement of current measures, or development of novel measures, of postoperative morbidity might improve consensus in this area.
Urinary retention is a common postoperative complication associated with bladder overdistension and the risk of permanent detrusor damage. The goal of this study was to determine predictive factors ...of early postoperative urinary retention in the postanesthesia care unit (PACU). We prospectively collected, in 313 adult patients, variables including age, gender, previous history of urinary tract symptoms, type of surgery and anesthesia, intraoperative administration of anticholinergics, amount of intraoperative fluids, IV morphine titration, and bladder volume on entry to the PACU. For each patient, bladder volume was measured by ultrasound on entry and before discharge from the PACU. Urinary retention was defined as a bladder volume larger than 600 mL with an inability to void within 30 min. Predictive factors were identified by multivariate analysis. The incidence of urinary retention in the PACU was 16%. In the multivariate analysis only the amount of intraoperative fluids (≥750 mL; P = 0.02; odds ratio = 2.3), age (≥50 yr; P = 0.008; odds ratio = 2.4), and bladder volume on entry to PACU (≥270 mL; P = 0.0001; odds ratio = 4.8) were found to independently increase the risk of urinary retention. Considering the clinical impact of undiagnosed postoperative urinary retention, these results suggest systematic evaluation of bladder volume with a portable ultrasound device in the PACU, especially in patients with risk factors.
Introduction: The general objective was to determine the epidemiological, clinical, paraclinical, therapeutic and evolutionary aspects of connectivitis in the dermatology department of the CHU ...Aristide Le Dantec. Patients and methods: This was a retrospective and descriptive study conducted in the Dermatology Department of the University Hospital Center (UHC) Aristide Le Dantec (HALD) of Dakar between January 2009 and December 2019. Their diagnoses were retained according to the international criteria validated in the course of connectivites Results: We identified 290 cases of connectivitis. Systemic scleroderma was the most frequent in 34.42% (n=94), followed by systemic lupus in 25.86% (n=75), mixed connectivities in 22,06% (n=64) and dermatomyositis in 19,32% (n=56). Cancer was associated with dermatomyositis in 11 cases and with systemic scleroderma in 3 cases. The mean age of our patients was 38.23 years. The sex ratio was 4.2 and the mean duration of evolution was 25 months. Dermatological manifestations were constant, found in all patients. In systemic lupus, they were dominated by discoid lupus lesions found in 40% and hypochromic spots (86%) in systemic scleroderma. In dermatomyositis, skin lesions were dominated by periorbital erythroedema (66.07%). Joint manifestations were found in 56.89% of cases (n= 165), muscular manifestations in 41.37% of cases (n= 120) and pleuropulmonary manifestations in 31.3% of cases (n=91). Neuropsychiatric manifestations were noted in 5.17% of cases (n=15). All our patients were treated with corticosteroid therapy and 12.06% of them had received immunosuppressive treatment, the most commonly used molecules being methotrexate (3.44%) and cyclophosphamide (8.27%). Hydroxychloroquine was prescribed in 59.31% of patients, while D-penicillamine was prescribed in 42.06% of patients, 100% of whom were treated for systemic scleroderma. The main complications encountered were infectious complications in 83 cases (28.6%). Visceral complications, a type of visceral insufficiency, were noted in 4.13% of cases. Conclusion: Our study demonstrates the frequency of connectivitis in the dermatology department. Its particularity was the predominance of systemic scleroderma over lupus which was classically the first connectivite in dermatology services. The delay in diagnosis noted is correlated with visceral attacks; hence the importance of a better knowledge of these affections for an early management.
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