The Pan African medical journal
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Case Reports
[Asystole during surgery to manage small intestine cancer: are we dealing with anaphylaxis or carcinoid crisis].
Cardiac arrest in the operating room is a life-threatening event with multiple causes. We report the case of a 53-year old female patient with no particular past medical history scheduled for surgery to manage small intestine cancer. Twenty minutes after anesthetic induction the patient had asystole rapidly reversible after resuscitation measures. ⋯ No other complication occurred, the patient spent 24 hours in the Intensive Care Unit receiving sandostatine infusion. Urinary 5-HIAA values were very high and histological examination of the surgical specimen confirmed carcinoid tumor. This study aims to highlight the rarity of this entity and the importance of suspecting carcinoid crisis in patients with intraoperative complications during anesthesia for small intestine tumor surgery.
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The management of high-energy pilon fractures is still controversial. Open reduction and internal fixation are often associated with serious complications. Various methods have been used to treat these injuries, with variable results. ⋯ The movements of the ankle ranged from 0 to 20° of dorsiflexion and 5° to 40° of plantar flexion. Twenty patients had gone back to their preinjury profession. The ILIZAROV technique is a safe and a very effective treatment for severe pilon fractures with minimum complications and good healing results.
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Despite the increase of immunization coverage (administrative) of measles in the country, there are widespread outbreaks of measles. In this respect, we investigated one of the outbreaks that occurred in hard to reach kebeles of Guji Zone, Oromia region, to identify the contributing factors that lead to the protracted outbreak of measles. ⋯ We conclude that low routine immunization coverage in conjunction with low access to routine immunization in hard to reach areas, low community awareness in utilization of immunization service, inadequate cold chain management and delivery of a potent vaccine in hard to reach woredas/kebeles were likely contributed to the outbreak that's triggered a broad spread epidemic affecting mostly children without any vaccination. We also figured that the case-based surveillance lacks sensitivity and timely confirmation of the outbreak, which as a result outbreak response immunization were delayed. We recommend establishing reaching every child (REC) strategy in Guji zone with particular emphasis too hard reach areas to enhance the current immunization service, and furthermore to conduct data quality self-assessment or cluster coverage survey to verify the reported high vaccination coverage in some kebeles. We also recommend conducting the second opportunity as a form of supplemental immunization activities in 2-3 year interval or consider the national second dose introduction in the routine immunization system to improve population immunity. We further recommend that there is a need to boost the sensitivity of case-based surveillance system to be able to early detect, confirm and react to future epidemics.
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Expanded programme on immunizations in resource-limited settings currently measure vaccination coverage defined as the proportion of children aged 12-23 months that have completed their vaccination. However, this indicator does not address the important question of when the scheduled vaccines were administered. We assessed the determinants of timely immunization to help the national EPI program manage vaccine-preventable diseases and impact positively on child survival in Senegal. ⋯ A significant delay in receipt of infant vaccines is found in Senegal while vaccine coverage is suboptimal. The national expanded program on immunization should consider measuring age at immunization or using seroepidemiological data to better monitor its impact.
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Postoperative sore throat is listed from the top as patients' most undesirable outcome in the postoperative period. It is believed to originate from mucosal dehydration or edema, tracheal ischemia secondary to the pressure of endotracheal tube cuffs, aggressive oropharyngeal suctioning, and mucosal erosion from friction between delicate tissues and the endotracheal tube. Even if the problem was indicated in many literatures, it has never been studied in our country. The study aimed to assess prevalence and factors associated with postoperative sore throat among patients who were operated under general anesthesia with endotracheal intubation. ⋯ The prevalence of postoperative sore throat was high in Gondar University Hospital. Awareness creation about the problem should be made for health professionals and postoperative sore throat management protocol need to be introduced.