Background GISTs are rare tumors but the most frequent mesenchymal tumors of the digestive tract. Diagnosis and treatment are challenging in low-income countries due to relatively poor access to ...immunohistochemistry and targeted therapy. In Africa, there are few studies about it. Imatinib, an oral targeted therapy, has been available in Benin since 2010 and free since 2016. This study describes the diagnosis and therapeutic management of GIST in Cotonou, Benin. Methods This is a descriptive cross-sectional study, with retrospective data collection over a 10-year period from 2010 to 2020, focused on patients with histological confirmed gastro-intestinal stromal tumor (GIST). Cases were identified using the registry database and the archival files of the Hubert Koutoukou Maga National University Hospital of Cotonou (CNHU-HKM). Results Fifteen GISTs were identified during the study period. The median age was 52 and the sex ratio was 2:1 (10 males and 5 females). The most frequent symptom was abdominal pain (n = 12). Delay in care seeking after onset of symptoms ranged from 24 h to 15 years. The most common site for GISTs was the stomach (n = 8). The median tumor size was 11 cm and the majority (n=10) was metastatic or locally advanced at the time of diagnosis. The tumors were often spindle-shaped at histology (n = 13) and the majority expressed KIT (n = 14). Most of the tumors (n = 12) were at high risk of recurrence according to the Joensuu scoring system. The availability of imatinib has improved the outcome of GIST with response in all cases it was used in neoadjuvant setting (n = 7). Conclusion GISTs are rare tumors and preferentially affect the stomach in Cotonou). Most of the tumors were large, unresectable at the time of diagnosis and at high risk of recurrence. Access to imatinib has revolutionized the management of those tumors in our country. Keywords: GIST, Access to treatment, Surgery, Imatinib, Low-income country, Benin republic
A low adherence to recommendations on antibiotic prophylaxis has been reported worldwide. Since 2009, cesarean sections have been performed under user fee exemption in Benin with a free kit ...containing the required supplies and antibiotics for prophylaxis. Despite the kit, the level of antibiotic prophylaxis achievement remains low. We conducted a convergent parallel design study in 2017 using a self-administered questionnaire and interviews to assess the knowledge and explore the beliefs of healthcare professionals regarding antibiotic prophylaxis in three hospitals. Of the 35 participants, 33 filled out the questionnaire. Based on the five conventional criteria of antibiotic prophylaxis, the mean level of knowledge was 3.3 out of 5, and only 15.2% scored 5 out of 5. From the verbatim of 19 interviewees, determinants such as suboptimal patient status health, low confidence in antibiotics, some disagreement with the policy, inappropriate infrastructures and limited financial resources in hospitals, poor management of the policy in the central level, and patient refusal to buy antibiotics can explain poor practices. Because of the dysfunction at these levels, the patient becomes the major determinant of adequate antibiotic prophylaxis. Policymakers have to consider these determinants for improving antibiotic prophylaxis in a way that ensures patient safety and reduces the incidence of antimicrobial resistance.
The intense use and misuse of antibiotics is undoubtedly the main factor associated with the high numbers of antibiotic-resistant pathogenic and commensal bacteria worldwide. In low-income countries, ...this misuse and overuse is widespread, with great consequences at the personal and global levels. In the context of user fee exemptions in caesarean sections, we performed a descriptive study in women to assess the use of antibiotics on three levels-antenatal, during caesarean section, and postpartum-in four Beninese hospitals. Out of the 141 women included, 56.7% were using antibiotics. More than the half (71.3%) were taking more than one antibiotic, either for a long time or in acute treatment. In prophylaxis, the timing, dose, and duration of administration were not correctly achieved. Only 31.2% of women received optimal antibiotic prophylaxis. Various antibiotics including broad-spectrum molecules were used in the patients after caesarean section. The use of antibiotics was improper on the three levels studied. The high rate of self-administered antibiotics, the poor achievement of antibiotic prophylaxis, and the postpartum overuse of antibiotics showed a poor quality of care provided in pregnancy. A national policy is essential to improve the use of antibiotics by the general public as well as by professionals.
Background
Internal hernias and the appendicular tourniquet are two rare pathologies.
Case presentation
We report here a case of a 68-year-old obese patient, who has acute small bowel obstruction due ...to strangulated internal hernia through an appendicular tourniquet. This appendicular tourniquet results from the adhesion between the tip of the appendix and its body. This obstruction was complicated by plugged perforation. Resection of the small bowel segment was performed, in addition to appendectomy, lavage, and drainage. The postoperative recovery was uneventful.
Conclusion
Acute bowel obstruction secondary to strangulation of an internal hernia through an appendicular tourniquet is exceptional.
L'objectif de cette étude était de déterminer la fréquence et les facteurs associés à la dénutrition chez les patients opérés en chirurgie viscérale en 2014. Il s'est agi d'une étude transversale, ...descriptive et analytique couvrant la période du 11septembre 2014 au 11 décembre 2014. La population d'étude était constituée des patients opérés en chirurgie viscérale au Centre National Hospitalier Universitaire Hubert Koutoucou MAGA de Cotonou. La dénutrition a été définie pour un indice de masse corporelle inférieur à 18,5 kg/m2. Au total 90 patients avaient été inclus dans l'étude, 57,78 % (52 patients) étaient de sexe masculin. La moyenne d'âge des patients était 55±6,32 ans. La dénutrition était observée chez 42 patients (46,67%). Les facteurs associés à la dénutrition chez les patients en postopératoire étaient : l'âge supérieur ou égal à 50 ans, les apports énergétique, protéique et hydrique faibles, la diarrhée, la présence de cancer, la chirurgie sur le tractus digestif, la chirurgie urgente, une perte de poids significative et l'hyperleucocytose. La dénutrition est fréquente chez les patients en postopératoire. Elle nécessite un dépistage et une prise en charge précoces.
Assessment of the Quality of Injectable Antibiotics in Benin Dohou, Angèle Modupè; Yémoa, Achille Loconon; Guidan, Dodji Boris Aurel ...
The American journal of tropical medicine and hygiene,
07/2022, Letnik:
107, Številka:
1
Journal Article, Web Resource
Recenzirano
Odprti dostop
Substandard and falsified medicines are an enormous threat to global health. Poor quality antibiotic preparations contribute to the development of antimicrobial resistance. In surgery, where the ...occurrence of healthcare-associated infections is high, healthcare teams need to rely on the quality of antibiotic prophylaxis to prevent infections. We assessed the quality of antibiotics used for surgical infection prophylaxis in Benin. Thirty-three samples were collected from six hospitals located in various departments in Benin. The antibiotics (powders for injection: amoxicillin + clavulanic acid, ampicillin, ceftriaxone; solutions for injection: ciprofloxacin, gentamicin, metronidazole) were assessed using visual inspection, pharmacotechnical tests (including uniformity of mass, pH measure, sterility test, and active pharmaceutical ingredient identification), and assay tests (including a simple analytical method thin layer chromatography) and complex analytical techniques (ultraviolet-visible spectrophotometry, high-performance liquid chromatography-diode-array detection, conductometry). Because the material needed for the methods recommended by the pharmacopeias to assess the dosage of gentamicin was not available, we developed and validated a conductometry method. Results showed that 97% (n = 32) of the samples passed visual inspection; 100% (n = 33) of the samples passed the pharmacotechnical tests, identification of active ingredients, and sterility test; 88% (n = 29) passed the test for percentage of active pharmaceutical ingredients. Overall, 15% of the samples did not pass the quality test (3% on visual inspection and 12% for excess active ingredients). Although most of the samples passed the quality tests, it appears important to perform routine quality control for intravenous medicines.
The occurrence of a left hepatic vein injury during laparoscopic removal of an adjustable gastric band is exceptional and should be known by any surgeon approaching the hiatal region. We report here ...the laparoscopic control of such a wound.
A 39-year-old morbidly obese woman (body mass index 47.7 kg/m2) presented the failure in weight loss following a laparoscopic adjustable gastric banding. It was decided to perform a one-step laparoscopic Roux-en-Y gastric bypass. Laparoscopic exploration showed post-surgical tissular retraction and adhesions. After the lap-band™ removal the left hepatic vein was accidentally bluntly injured while freeing adhesions between left hepatic lobe and the stomach. After a direct hemorrhagic control, intraoperative diagnosis of left hepatic vein injury was confirmed. A laparoscopic repair was performed by two running sutures using absorbable monofilament 4/0. Then, a Roux-en-Y gastric bypass was performed without any other complications. Operative time was 119 min; intraoperative blood loss was estimated as 200 cm3. No blood transfusion was necessary. The total hospital stay was 48 h. The excess weight lost after 10 years was 87,9%.
Adjustable gastric band can modify anatomic landmarks, leading to a wrong dissection path, with possibility of left hepatic vein injury.
The left hepatic vein injury can occur during revisional surgery for laparoscopic adjustable gastric banding failure. Its laparoscopic management can be done safely, in trained hands without increasing morbidity.
•Major vascular injury can occure during revisional surgery for Failed Gastric Banding•chronic inflammatory changes induced by the adjustable gastric band can lead to a wrong dissection path and explain that complication•the skilled laparoscopic surgeon can attempt a vascular repair without converting,•closing the vascular wound with atraumatic grasper is the first step of laparoscopic repair•if minimal risk for patient safety or technical feasibility arisen, the conversion must be immediate.
Introduction : Les traumatismes du pénis intéressant le réseau vasculaire sont rarement rapportés dans la littérature. La rupture de la veine profonde du pénis est une urgence urologique dont la ...clinique peut simuler une fracture de la verge. Nous rapportons un cas de rupture de la veine profonde du pénis survenue lors d’un faux pas de coït. Patient et Méthodes : Il s’est agi d’un patient âgé de 26 ans présentant une tuméfaction de tout le pénis précédée d’une douleur minime et d’une détumescence progressive survenue au décours d’un coït. L’exploration chirurgicale a mis en évidence une lésion incomplète de la veine dorsale profonde et qui a été réparée. Conclusion : La rupture de la veine dorsale profonde est rare et peut simuler une fracture des corps érectiles. . L’exploration chirurgicale reste un moyen diagnostique et thérapeutique accessible.
Low-grade endometrial stromal sarcomas are relatively rare tumors. We here report a case of a woman presenting with a giant metastatic low-grade endometrial stromal sarcoma with thromboembolic ...complications requiring urgent surgical management.
A 58-year-old obese female was admitted, with a voluminous abdominopelvic mass, due to complications related to its size and extent. The tumor derived from the uterus and invaded the ureters, bladder and rectum. It compressed the right iliac vessels causing both deep vein thrombosis and pulmonary embolism. She developed a painful irreducible umbilical. We proceeded with a debulking surgery (hysterectomy with bilateral salpingo-oophorectomy). Histological findings were consistent with a low-grade endometrial stromal sarcoma.
Low-grade endometrial stromal sarcomas are generally low-grade malignant neoplasms with an indolent clinical course. Surgery is the cornerstone of treatment. In low-income countries, malignancies are more often diagnosed at a late stage, which limits therapeutic options. Cytoreduction is recommended in advanced tumors with extrauterine manifestation, depending on symptoms and with palliative intent.
Low-grade endometrial stromal sarcomas are indolent uterine malignancies with metastatic potential. Even in advanced cases, cytoreduction must be considered.
•Endometrial stromal sarcomas (ESS) are relatively rare tumors.•They are classified into three categories: low-grade, high-grade, and undifferentiated.•Staging is the most important prognostic factor.•Cytoreduction surgery is recommended even in advanced tumors.•Late presentation of cancers is commonplace in most low-income countries.
The increasing worldwide prevalence of extended-spectrum beta-lactamase (ESBL) producing
constitutes a serious threat to global public health. Surgical site infections are associated with high ...morbidity and mortality rates in developing countries, fueled by the limited availability of effective antibiotics. We used whole-genome sequencing (WGS) to evaluate antimicrobial resistance and the phylogenomic relationships of 19 ESBL-positive
isolates collected from surgical site infections in patients across public hospitals in Benin in 2019. Isolates were identified by MALDI-TOF mass spectrometry and phenotypically tested for susceptibility to 16 antibiotics. Core-genome multi-locus sequence typing and single-nucleotide polymorphism-based phylogenomic methods were used to investigate the relatedness between samples. The broader phylogenetic context was characterized through the inclusion of publicly available genome data. Among the 19 isolates, 13 different sequence types (STs) were observed, including ST131 (
= 2), ST38 (
= 2), ST410 (
= 2), ST405 (
= 2), ST617 (
= 2), and ST1193 (
= 2). The
gene encoding ESBL resistance was found in 15 isolates (78.9%), as well as other genes associated with ESBL, such as
(
= 14) and
(
= 9). Additionally, we frequently observed genes encoding resistance against aminoglycosides
,
= 14, quinolones (
,
= 4), tetracyclines
(
),
= 14, sulfonamides (
,
= 14), and trimethoprim (
,
= 13). Nonsynonymous chromosomal mutations in the housekeeping genes
and
associated with resistance to fluoroquinolones were also detected in multiple isolates. Although the phylogenomic investigation did not reveal evidence of hospital-acquired transmissions, we observed two very similar strains collected from patients in different hospitals. By characterizing a set of multidrug-resistant isolates collected from a largely unexplored environment, this study highlights the added value for WGS as an effective early warning system for emerging pathogens and antimicrobial resistance.
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