Introduction:The practice of spinal anesthesia in pediatric surgery is declining, especially in countries with limited means. What about in our context? Objective: To evaluate the practice of spinal anesthesia in pediatric surgery in Togo. Framework and method of study: This was a prospective study from November 2017 to May 2018 in pediatric surgery at CHU SO de Lomé, in the operating room and hospital ward of CHU Kara. The surgical, anesthesiological and evolutionary aspects of the patients were analyzed. Results: Sixty children were selected for the study who had an indication for sub-umbilical surgery. The male sex was predominant (73.3%). 47 (78.30%) patients were operated on for scheduled surgery. Hernia repair was the most performed surgical intervention (43.30%). The mean duration of the surgery was 78 ± 35.9 minutes. Most of the patients were ASA 1 (98.30%). The local anesthetic used was 0.5% isobaric Bupivacaine. Fentanyl was the predominant adjuvant (55%). The most widely used lumbar puncture needle was 25 Gauge with 75 millimeters in length (63.30%). Diazepam was the most widely used sedative (50%). The predominant spinal anesthesia protocol was spinal anesthesia alone (60%). Only one patient had hypotension (1.70%). Conclusion: The fairly satisfactory pediatric spinal anesthesia in Togo remains poorly performed. Its promotion involves the training of anesthesia practitioners and the strengthening of the technical platform.
Introduction: Hand hygiene (HH) is an effective way to fight infections in healthcare settings. The general purpose of our study was to explore the knowledge, attitudes and practices of health care providers on HH at Dapaong regional hospital (DRH). Methodology: This was a prospective, descriptive cross-sectional study conducted from March to June 2022 in the DRH wards. Data were collected using a questionnaire and observation grid. Results: 90 care providers were surveyed. Males and non-physician personnel predominated with 57.8%, and 94.4% respectively. The survey on staff's knowledge reported: 31.1% of practitioners did not wash their hands on arrival and departure in services. 24% did not know the difference between simple hand washing (SHW) and hygienic hand washing (HHW). 23.3% did not know the type of soap to use for HHW. The caregivers did not know the type of hand washing (HW) required after a septic and non-septic procedure in respectively 41.6%, and 37.8%. They did not know that there are two types of hand antiseptics (45.4%), nor the amount of antiseptic for HW (78.9%). The survey on staff's attitude regarding HW found that: 70% did not remove all jewels prior HW, and 51.1% did not know that wearing gloves cannot replace the HW. For HW Staff Practice: 62.2% did not wash their hands before treatment. 91.1% did not spread the soap on their hands and forearms after wetting them. 65.55% did not rinse hands from nails to elbows. Conclusion: The HH was poorly known, the attitude of the staff was dangerous in relation to the HH and the practice of HH was very inadequate at the RHC-Dapaong. As a result, there is a need to retrain staff to increase their capacity to prevent care-related infections and enhance pa-
Bilateral fracture of clavicle are rare. The injury mecanism is difficult to specify and there are sevral hypotheses that have been developed. The management can be orthopedics or chirurgical. We reported the 52 years man who presented a bilateral fracture of clavicle following a trafic road accident. The management was chirurgical with satisfatory result.
Purpose: Primary malignant musculosqueletal tumors in adult are rare affections group and its treatment is still a real challenge today. The aim of this work was to describe the epidemiologic and treatment aspects of these tumors in the national reference center of our country. Materiel and Methods: It was a retrospective review of primary malignant musculosqueletal tumors treated in orthopedics and trauma unit of Sylvanus Olympio teaching hospital of Lomé, Togo from January 2000 to December 2014. Results: During the study period, 28 cases were selected and reviewed. There were 17 men (60.71%) and 11 women (39.29%). The average age was 32.7 years. There were 20 cases (71%) of primary malignant bone tumors (PMBT) and 8 cases (29%) of primary malignant soft tissues tumors (PMSTT). There were 6 (30%) of osteosarcoma. The tumor was located in the bones of the forearm and wrist/hand in 2 (10%) patients for each anatomical site; for the lower limb, around knee in 7 (35%) patients. Eight patients had PMSTT (28, 57%). There were three cases of rhabdomyosarcoma, 2 cases of fibrosarcoma. Tumors were located around knee in 4 cases and around ankle/foot in 3 cases. In the two groups of tumor, tumor resection was performed in 5 patients (17.86%) and limb amputation indicated in 23 patients (82.14%), was performed in 15 (53.57%) and 8 patients (37.78%), rejected it and left hospital against medical advice. Conclusion: Malignant musculoskeletal tumors are relatively rare in Togo. Their treatment is based on radical surgery which is often not supervised by adjuvant therapies. Ignorance, poverty of the population and embryonic state of diagnostic and treatment infrastructures are the obstacles to their care. Education and awareness must be integrated to care and fight against this group of diseases.
Background: To identify predictors of humerus shaft fractures nonunion in adults whatever the type of treatment performed. Patients and Methods: We conducted a retrospective study among patients who had a fracture of the humeral shaft moving towards healing or nonunion. Patients were treated in the orthopedic trauma unit of Sylvanus Olympio Teaching Hospital and two other private clinics in Lomé between January 2008 and June 2012. On the X-ray of each patient, we measured the angulation, the diastasis, and inter fragmentary contact. For each included patient, we looked for: age, sex, medical history, body mass index (BMI), according to the third location of the shaft fracture, the type of fracture according to AO classification and the type of opening according Tscherne classification. Results: During the study period, 184 patients with humeral shaft fracture were identified. Of these 108 were men. The mean age of patients was 37.3 years. The fractures were treated conservatively in 100 patients (54.3%), 78 treated surgically and six (3.3%) have discharged from hospital against medical advice for traditional treatment. The factors that were associated with nonunion of humerus shaft fractures in these patients were: the opening of the fracture (RR = 4.5; 95% CI = [2.9; 7.1]), the presence of immediately radial paralysis (RR = 5.6; 95% CI = [3.7; 8.5]), the existence of other associated lesions or fracture (RR = 1.8; 95% CI = [1.1; 3.1]), energy of the trauma (RR = 2.3; 95% CI = [1.3; 4.4]) and type III classification of Tscherne (RR = 0.3; 95% CI = [0.2; 0.6]). After multivariate analysis, factors that remained significantly associated with the failure of consolidation were: the existence of diastasis > 2 mm (OR = 7.6; 95% CI = [2.2; 25.6)), the Body Mass Index (BMI) > 25 (OR = 1.3; 95% CI = [1.1-1.6]) and the existence of other bone lesion (OR = 4.3; 95% CI = [1.4-18.9]). Conclusion: BMI greater than 25, the existence of an interfragmentary gap of more than 2 mm and existence of other bone lesions are significant risk factors for nonunion in humerus shaft fractures. The traditional treatment, common singular factor to the African environment, should not be ignored. Control of these predictors is necessary in carrying out the treatment of humerus shaft fractures.
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