Assang Dossim

Risk Factors for Surgical Wound Infection in HIV-Positive Patients Undergoing Surgery for Orthopaedic Trauma

Purpose. To identify risk factors associated with surgical wound infection in patients infected with human immunodeficiency virus (HIV) undergoing surgery for orthopaedic trauma. Methods. Records of 29 male and 7 female HIV-positive patients aged 18 to 47 years who underwent surgery for orthopaedic trauma were reviewed. Data on HIV-specific variables (HIV clinical classification, CD4+ lymphocyte count) and highly active antiretroviral therapy were retrieved, as were data on wound class, fracture type, surgery type, surgical wound infections, and outcomes. Possible risk factors associated with surgical wound infection were analysed. Results. The median follow-up period was 27 (range, 19–41) months. Of the 36 patients, 14 (39%) developed surgical wound infections (4 were deep and 10 superficial). 89% and 67% of them were in HIV clinical category B and in CD4+ T-lymphocyte category 3, respectively. 12 of these infections resolved after debridement and prolonged antibiotic treatment, and 2 developed chronic osteomyelitis. Four of the patients had non-union. Surgical wound infections were associated with HIV clinical category B (p<0.001), CD4+ T-lymphocyte category of ≥2 (p=0.041), and contaminated wounds (p=0.003). Conclusion. Identification of risk factors may help minimise morbidity in HIV-positive patients.

Intramedullary fixation using multiple Kirschner wires for forearm fractures: a developing country perspective.

Purpose. To evaluate treatment results of intramedullary fixation using multiple Kirschner wires for diaphyseal forearm fractures. Methods. Between January 2001 and January 2004, 184 patients (122 men and 62 women) with 288 displaced diaphyseal forearm fractures underwent intramedullary fixation using multiple Kirschner wires. The wires were inserted by opening the fracture site because radiographic facility for closed pinning was unavailable. The time to union, functional recovery, and the complication rates were assessed. Results. 11 patients were lost to follow-up, leaving 173 whose data was analysed. In 167 (97%) of the patients the fractures united, and in 14 (8%) of them union was delayed. The mean time to union for closed fractures was 13 (range, 7–16) weeks and for open fractures it was 15 (range, 12–22) weeks. The mean time in cast was 6 (range, 3–14) weeks. In all, 34/173 (20%) had complications: superficial infection (n=13), deep infection (n=4), cross-union between bones (n=4), open fracture ‘needing’ a skin graft (n=2), radial nerve palsy (n=3), paraesthesia (n=1), and non-union (n=7). Among the 173 analysed patients, the infection rate was 10% and the non-union rate was 4%. 130 (75%) of the patients had the wires removed; no re-fracture occurred after wire removal. Based on the Anderson criteria, 47 (27%) of the patients attained excellent, 78 (45%) satisfactory, and 39 (23%) unsatisfactory results. In 9 (5%) of the patients, union failed (7 plain non-union and 2 due to chronic osteomyelitis). Conclusion. Kirschner wires are much cheaper than plates and screws, and require minimal expertise for insertion and removal. They remain acceptable for stabilising displaced diaphyseal forearm fractures in developing countries.

Hématomes Extraduraux Chez L’adulte Au Togo

The aim of this present study is to help people suffering from cardiovascular diseases by designing and implementing a digital bracelet that allows keeping a record of cardiac behavior to generate a more optimal diagnosis of the patients current state and the evolution of the heart rate of the same patient. The research used the evolutionary methodology. This methodology consisted of three stages: specification, development, and validation. In this study, 95% reliability was used. The results obtained with the present study were favorable. In addition, the digital bracelet has an important acceptance both in the patients and in the doctors who attended the people with cardiovascular disease.The ideal, the spiritual and the most important element of motivational intelligence is cooperation. The idea is to focus on helping with motivational problems where the customer is not ready or willing to change or have a sense of ambivalence. It is certain that motivational intelligence is not a collection of techniques. This involves the attitude of the therapist, who does not assume absolute authoritarian attitude and is more of a partner, and rather is to investigate the clients problems with the exclusion of the attitude of giving instruction, moralistic recommendations. It is generally about support and more about creating a friendly interpersonal atmosphere that encourages cooperation. The therapists tone of wisdom is not acceptable, but rather the actual picture of the condition being extracted from the patient. This method is more like Socrates than university lecturer. The form of educare, mining is the most appropriate. The goal is to discover within yourself the motivation for change and its extraction. The article describes the motivational intelligence technique as a tool for social workers.The presented contribution attempts to introduce a phenomenologicalexistential analysis of experiencing beauty (aesthetic experience) through Heidegger’s approach to the examination of state-of-mind. It points out a topic which no doubt extremely interested Heidegger, but which he did not approach by the method he offered in Being and Time. The text thus attempts to reconstruct what Heidegger’s answer to the question “what is beauty?” might have sounded like in this period of his work. The offered analysis respects the original structure of the question regarding the state-of-mind and examines beauty from three viewpoints: 1) what beautiful objects have in common and what characterises them, 2) what characterises aesthetic experience, and finally, 3) what matters to us in an aesthetic experience. Thus it attempts to interpret beauty within Heidegger’s understanding of being and being-in-theworld before the “turn” in his thinking. The study points to the cognitive aspects of aesthetic experience in the sense of understanding beauty as the uncovering of being and the truth of the world.Communism is the ideology which aims at exterminating all religions as, it is believed, they are harmful to social life. Therefore, after the 2nd World War, under the arrangements between the allies, communists took control in Poland and started to gradually but systematically eliminate the influence of the Church and the Catholic religion on the society. Due to the confrontational attitude of the ruling party towards the Church, the relations between the Polish Episcopate and the communist authorities were dominated by the permanent, mainly ideological, conflicts. The breakthrough happened as late as in the 80s of 20th century. At that time, not only did the relations between the former enemies improve but they both started to work together towards the normalization and humanization of the relations between the communist regime and the Episcopate. The result was the participation of the representatives of the Episcopate in the behind-closed-doors negotiations in Magdalenka which happened before the deal between the government and a part of the Solidarity opposition was signed at “the round table”. The main aim of this publication is to present the role of the Episcopate in the process of the political changes in Poland. In the 80s, the Episcopate constituted a specific and unique social group which brought together hierarchs who had various attitudes towards the communist authorities. What caused the internal tensions and divisions within the Episcopate were the Church representatives making deals with the former oppressors as well as various attitudes of bishops towards the ruling party. On the basis of the secondary sources, the author of the publication will attempt to present the role of the Episcope in the moderation of the agreements which became the backbone of the political changes in Poland, i.e. the transformation of communism into post-communism.

Significant loss of Bone and Skin- Muscle Post Traumatic of Elbow: Support Strategy in a Developing Country

Purpose: The elbow bone traumas are very serious lesions that can compromise the function of this joint in the future. These lesions are most severe when there is a defect of bone which affects one component of the joint.

A Technique for Treatment of Overdrainage in Ventriculoperitoneal Shunt

Background and Importance: Overdrainage is a complication of ventriculoperitoneal shunt but adjustable valves and anti-siphon devices can prevent it. These very expensive valves are most often inaccessible, so that the majority of the valves available in Togo are fixed differential pressure valves. Although overdrainage is a widely-known issue, we aimed to introduce a new risk factor and the way we manage this complication.

Hand replantation: First experience in a sub-Saharan African country (Togo)

Fifty years after Chen has performed the first forearm replantation, we report our first case of hand replantation in a sub-Saharan African country. The etiology of the amputation was machete due to interpersonal violence. The amputation was trans-carpal, guillotine-type, subtotal non-viable maintained with a small skin bridge. The replantation procedure was successful. At one year follow-up, the functional result according to Chens criteria was excellent. Through this first experience, we can state that hand replantation can be performed successfully both in survival and function in a non-specialized hospital of a sub-Saharan African country.

PLAIE ACCIDENTELLE DE L’ARTERE RADIALE LORS DE L’ABORD ANTERIEUR DE L’AVANTBRAS : INTERET DU NON USAGE DU GARROT

Purpose: this study aimed to analyze the epidemiological aspects and evaluate the impact of late diagnosis on prognosis of gastrointestinal surgical emergencies at the National Hospital of Zinder (Niger). Patients and method: this is a prospective study from 1 January to 31 December 2013. All patients underwent surgery for digestive emergency were included. Results: We collected 302 patients. Emergencies digestive surgery accounted for 22% of 1358 cases of surgical emergencies recorded over the period of the study period. The sex ratio is 3/1 in favor of men. The average age of patients was 23 years. Digestive surgical emergencies affect more children (45%) and young adults (43%). The majority (70%) of our patients did not attend school and 49% were from rural areas. The diagnosis delay rule, 171 patients (57%) arrived to emergency department more than 48 hours after onset of symptoms. Abdominal pain with or without other signs was the main reason for consultation (92% of patients). 182 patients had a poor general status. The etiologies were dominated by peritonitis (52%) followed by intestinal obstruction (28%), and abdominal trauma with 10% of cases. The parietal suppuration isolated or associated with other morbidities was the main postoperative (28%). The average length of hospital stay was 9 days. 36 patients (12%) had died. Almost half of the deaths (47%) occurred within the first 48 hours of admission. The delay of admission and the surgical management was statistically significant effect on the prognosis (P<0.006, p< 0.0001). Conclusion: The prognosis of gastrointestinal surgical emergencies is highly correlated with the speed of diagnosis leading to appropriate treatment as soon as possible. This promptness is the only guarantee of a decline in the high morbidity and mortality which is often linked to dysfunction of our hospitals and/or accessibility problems faced by patients.

Luxation antérieure bilatérale des épaules

Bilateral anterior shoulder dislocation is a very rare clinical entity. We report another case of traumatic bilateral anterior dislocation of shoulders. We discuss the mechanism of the dislocation which is unusual and the treatment.