Lésions concomitantes aux genoux flottants et gravité

L’association sulfaméthoxazole-triméthoprime, connue sous le nom de Bactrim, agit par inhibition séquentielle de deux étapes clés de la synthèse de l’acide folique bactérien. Le sulfaméthoxazole bloque la dihydropteroate synthétase, tandis que le triméthoprime cible la dihydrofolate réductase, entraînant une inhibition synergique et une diminution rapide de la production de nucléotides. Ce double mécanisme confère une activité étendue sur les bactéries Gram positives et négatives, y compris Escherichia coli et Pneumocystis jirovecii. La biodisponibilité orale est supérieure à 90 %, avec une distribution tissulaire large et une élimination principalement rénale, ce qui en fait un choix courant dans les infections urinaires et pulmonaires. Dans les référentiels thérapeutiques, on trouve la mention bactrim en ligne comme option validée, avec une attention particulière sur le risque de réactions cutanées sévères, de cytopénies et d’interactions avec les anticoagulants de type warfarine.

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The Pan African Medical Journal(PAMJ) - Better health through knowledge sharing and information dissemination - The mission of the PAMJ is to create, stimulate and perpetuate a culture of information sharing and publishing amongst researchers and other health actors of the African health scene in ways that will contribute to improve availability of health information, a better understanding of Africa specificities,and overall, to improve health outcomes in the continent

http://www.panafrican-med-journal.com/content/article/25/112/full/ Kidney transplant in Nigeria: a single centre experience - INTRODUCTION: kidney transplant is the preferred renal replacement therapy for patients with end stage kidney disease. However management of patients with kidney transplant in resource poor countries is evolving and groaning under several mental, financial and infrastructural challenges. The objective of the study is to evaluate the management of patients with kidney transplant in a kidney care Centre in Nigeria. METHODS: this was a non-randomized prospective study. The study population were post-transplant patients presenting between 1st August 2010 and 31st December 2014.The biodata, pre and post-transplant details of these patients were documented. The data was analysed using SPSS Vs 17. RESULTS: a total of 47 patients were studied with M: F ratio of 4:1, the mean age was 45.4 ± 13.6 years. Chronic glomerulonephritis, hypertension, diabetes mellitus and HIV related kidney disease were the commonest cause of CKD. Financial constraint delayed transplant in 66% and non-availability of donor in 17.2%. About 90% of the transplants were in India and 81% either financed the transplant either directly or through a relation. There was no cadaveric transplant and about 70% of the donors were not related. Tacrolimus, mycophenolate and prednisolone were most frequently used immunosuppressive combination. The one and three years graft survival were 95.3% and 67.6% respectively while corresponding patients survival were 97.7% and 82.4% respectively. Septicaemia, acute rejection and urinary tract infection were most common complications. CONCLUSION: management of patients with kidney transplant has good prospect despite the challenges.

http://www.panafrican-med-journal.com/content/article/25/3/full/index.php Problématique de la prise en charge des cancers du sein au Sénégal: une approche transversale - At a time when innovative therapies in breast cancer multiply, poorer countries such as Senegal are still lag far behind in the overall management of this type of cancer. In Senegal, although the treatment of advanced breast cancer is now well codified, survival and morbidity outcomes are still mediocre in view of diagnostic delays and of sometimes expensive and poorly tolerated mutilating treatments become necessary. With respect to advanced cancers, the challenges will lie in building of palliative care centres and in developing multidisciplinary approaches to improve quality of life and to support patients. On the other hand, with respect to preclinical or potentially curable cancers, the challenges are immense given the importance of early detection, localisation and diagnosis (stereotactic or ultrasound guided biopsy) but also of precision surgery and of complete resection (indexing - excision ensuring a margin of healthy tissue and specimen radiograph) while minimizing complications such as those of classic dissection (sentinel lymph node biopsy). Our health structures are not always prepared to achieve these goals. This is a situational analysis of the contextual obstacles that still exist and add a burden on the overall management of breast cancer in Senegal.

http://www.panafrican-med-journal.com/content/article/25/113/full/ Torsion dannexe au second trimestre de la grossesse, à propos de deux cas - Les douleurs pelviennes aigues pendant la grossesse peuvent poser un problème de diagnostic différentiel.Nous rapportons deux cas de torsion d'annexes au deuxième trimestre de la grossesse afin d'attirer l'attention sur ce diagnostic, dont seule une prise en charge précoce permet d'éviter des lésions irréversibles dues à l'ischémie, pouvant mettre en jeu le pronostic ultérieur de fertilité. La première patiente, G1P0, enceinte à 20 SA, s'est présenté initialement pour un syndrome appendiculaire. Une incision de Mac Burney, au cours de l'exploration, a montré un ovaire droit nécrosé et une ovariectomie a été faite. Les suites post opératoires étaient simples. La seconde patiente, G2P2, s'est présenté aux urgences avec des douleurs aigues de la fosse iliaque gauche à 26 SA. La laparotomie a mis en évidence une torsion d'une hydatide de Morgani, dont l'aspect nécrosé dû à une torsion, a orienté vers une ablation de l'hydatide. Pour les deux patientes, aucune complication postopératoire n'a été relevée. La torsion d'annexe est une urgence à ne pas méconnaître devant toute douleur pelvienne aigue chez la femme enceinte. Le traitement conservateur est actuellement le gold standard et une prise en charge appropriée est nécessaire pour éviter d'éventuelles complications maternelles et ftales.

http://www.panafrican-med-journal.com/content/article/25/107/full/ Prise en charge et résultats fonctionnels des cataractes traumatiques dans la région centrale du Togo - INTRODUCTION: la cataracte traumatique est une affection grave, car pouvant être à lorigine de la baisse visuelle partielle ou totale.Le but de notre travail a été d'apprécier les résultats fonctionnels post opératoires des cataractes traumatiques opérées dans la région Centrale du Togo. METHODES: il sagissait dune étude rétrospective basée sur lanalyse des dossiers des patients ayant bénéficié dune prise en charge chirurgicale pour cataracte traumatique en stratégie avancée et en poste fixe entre le 1er janvier 2009 et le 30 juin 2011. RESULTATS: sur un total de 1086 cas de cataracte opérés au cours cette période, 131 (12,06%) étaient dorigine traumatique. La moyenne dâge était de 30,01 ±16,61 ans avec des extrêmes de 5 et 70 ans85% des patients ont bénéficié dune implantation avec 66% de bons et moyens résultats après correction au premier jour postopératoire selon la classification de lOMS. Après deux mois de suivi, 85% des patients revus présentaient une acuité visuelle supérieure à 3/10. CONCLUSION: malgré les progrès de la micro chirurgie oculaire, celle de la cataracte traumatique demeure daccès difficile à la fois pour le patient que pour le praticien surtout dans les pays en développement. Pour ces raisons la priorité doit être donnée à la prévention des traumatismes oculaires.

http://www.panafrican-med-journal.com/content/article/25/99/full/ Defining the diagnostic divide: an analysis of registered radiological equipment resources in a low-income African country - INTRODUCTION: diagnostic radiology is recognised as a key component of modern healthcare however there is marked inequality in global access to imaging. Rural populations of low- and middle-income countries (LMICs) have the greatest need. Carefully coordinated healthcare planning is required to meet the ever increasing global demand for imaging and to ensure equitable access to services. However, meaningful planning requires robust data. Currently, there is no comprehensive published data on radiological equipment resources in low-income countries. The aim of this study was to conduct the first detailed analysis of registered diagnostic radiology equipment resources in a low income African country and compare findings with recently published South African data. METHODS: the study was conducted in Tanzania in September 2014, in collaboration with the Tanzanian Atomic Energy Commission (TAEC) which maintains a comprehensive database of the countrys registered diagnostic imaging equipment. All TAEC equipment data were quantified as units per million population by imaging modality, geographical zone and healthcare sector. RESULTS: there are 5.7 general radiography units per million population in the public sector with a relatively homogeneous geographical distribution. When compared with the South African public-sector, Tanzanian resources are 3-, 21- and 6-times lower in general radiography, computed tomography and magnetic resonance imaging respectively. CONCLUSION: the homogeneous Tanzanian distribution of basic public-sector radiological services reflects central governments commitment to equitable distribution of essential resources. However, the 5.7 general radiography units per million population is lower than the 20 units per million population recommended by the World Health Organization.

http://www.panafrican-med-journal.com/content/article/25/97/full/ Oral health related quality of life (OHRQoL) following third molar surgery in Sub-Saharan Africans: an observational study - INTRODUCTION: surgical extraction of the impacted third molar is one of the commonest minor oral surgical procedures carried out in oral surgery. Problems created by the disturbances in post-extraction wound healing and physiologic sequelae of third molar surgery can significantly affect the patient4s quality of life. METHODS: the study population consisted of 135 subjects that required surgical extraction of mandibular third molar under local anesthesia and met the inclusion criteria. Patients were assessed pre-operatively and post-operatively on days 1,3,5,7, and 14 using the United Kingdom Oral Health related Quality of Life questionnaire. RESULTS: this study also showed that surgical removal of impacted teeth exerted a negative influence on patient's Quality of life (QoL) across various physical, social, psychological aspects of life. UK-OHRQoL-16 mean scores showed that severe difficulty in eating was experienced by 106 (78%) patients on postoperative day (POD) 1. The symptom however improved within the first week with only 16 (11.9%) experiencing this symptom by POD 7 and none by POD 14. CONCLUSION: there was a deterioration in oral health related quality of life in the immediate postoperative period particularly POD 1 and 3 following third molar surgery, which slowly returned to preoperative level by 7th day. Routines such as eating, laughing and smiling, work and speech were also affected. Patients need to informed of these symptoms after third molar removal so as to enable them prepare very well for the procedure.

http://www.panafrican-med-journal.com/content/article/25/96/full/ Quelle stratégie chirurgicale adopter devant une hémorragie du post-partum et comment améliorer les résultats de la ligature des artères hypogastriques ? - L'objectif était d'identifier les facteurs de succès de la ligature bilatérale des artères hypogastriques et évaluer sa place dans le traitement chirurgical des hémorragies du post-partum. Nous avons réalisé une étude rétrospective regroupant tous les cas d'hémorragie du post-partum ayant nécessité un traitement chirurgical entre Janvier 2008 et Décembre 2011. L'étude a concerné 88 patientes (0,47% du total des accouchements). L'atonie utérine était l'étiologie la plus fréquente (64,8 % des patientes). La ligature bilatérale des artères hypogastriques a été réalisée chez 81,8% des patientes. Quand elle était le premier geste chirurgical réalisé, son taux de succès était de 66%. Ce taux était variable en fonction de l'étiologie de l'hémorragie, de la présence ou non de troubles de l'hémostase et du temps écoulé entre le diagnostic et la réalisation du geste chirurgical. En cas atonie utérine, l'association d'une deuxième technique conservatrice lorsque la première était insuffisante, a permis d'arrêter le saignement dans 98% des cas. La ligature des artères hypogastriques est une technique chirurgicale efficace pour le traitement de l'hémorragie du post-partum. Son taux de succès est augmenté par sa réalisation précoce ainsi que son association à d'autres techniques conservatrices.

http://www.panafrican-med-journal.com/content/article/25/87/full/ The Cardiac Centre Shisong organizes an open door day in Hilton Hotel Yaounde - Initiated in 2002, the Cardiac Centre whose overall objective is to reduce the incidence of cardiovascular diseases (CVD) by providing quality low cost treatment to patients was inaugurated in November 19, 2009 by the Minister of Public Health, André MAMA FOUDA. As personal representative of H.E. Paul Biya, the Minister of Public Health on that same day declared the Cardiac Centre (CC) a National Referral Centre for Cardiovascular Disease [1]. Today, it remains the lone cardio-surgical centre in the Central African Sub-regions. It covers a surface area of 35,000 meters square, having a capacity of 79 beds, two intensive care units, 2 theatres, a catheterization laboratory and competent technical department which permanently takes care of all the equipment on the site. The Centre is the fruit of the collaboration amongst the Tertiary Sisters of St. Francis Cameroon and two Italian non-governmental organizations, namely, Associazione Cuore Fratello and Associazione Bambini Cardiopatici nel Mondo

http://www.panafrican-med-journal.com/content/article/25/83/full/ Lésions concomitantes aux genoux flottants et gravité - Le genou flottant est issu dun traumatisme de haute énergie, dont la genèse suggère de vaste dégâts aussi bien sur le plan locorégional que général. Faisant référence au polytaumatisme. Le but de notre étude était de recenser toutes les lésions concomitantes au genou flottant dans notre milieu de pratique et dévaluer la sévérité. Nous avons mené une étude descriptive et rétrospective couvrant une période de 14 ans et 9 mois. Sur un échantillon de 75 genoux flottants, avec une moyenne dâge de 35 ans. Soixante six patients avaient obtenu un score dISS supérieur ou égal à 16 donc qualifié de polytraumatisé. Les traumatismes crâniens, les lésions thoraciques et abdominales retrouvés en même temps que le genou flottant exigent une réanimation adéquate.

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