ABSTRACT
Introduction: Nosocomial infections (NI) are common conditions among hospitalized patients. This study aimed to evaluate healthcare workers' knowledge and practices regarding infection prevention measures in intensive care units. Method: This was a descriptive, cross-sectional study conducted from April 13to June 10, 2022, among 45 healthcare workers in three university teaching hospitals of Abidjan. The parameters studied were: the theoretical and practical knowledge of healthcare workers regarding the prevention of nosocomial infections. Results: 45 healthcare workers participated. 74.7% knew the definition of a nosocomial infection and 43% identified the main risk factors for its occurrence. Sixty-five percent identified staff hands as the main mode of cross-transmission of germs between patients. Sixty-four percent of staff reported using non-sterile gloves during urinary catheter insertion. Compliance with hand hygiene before patient contact was low (31.8%) while gloves changes between patients were observed in 87.2% of cases. Deficiencies were noted in adherence to aseptic techniques before performing invasive procedures. Non-compliance was mainly attributed to shortages of supplies and personnel, and insufficient knowledge of preventive measures. Conclusion: healthcare workers’ knowledge and adherence to hygiene practices in intensive care units were insufficient.

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Introduction: The management of caesarean sections in women with heart disease in resource-limited countries is a major challenge. Lack of infrastructure, poor access to specialized care and socio-cultural barriers worsens the maternal-foetal prognosis. Objective: To describe our experience of anaesthesiologic management of caesarean sections in parturient with heart disease, identifying the difficulties encountered and prognostic factors. Patients and Methods: Cross-sectional, descriptive and analytical study conducted prospectively over one year (January-December 2023). All parturient with cardiac disease referred for scheduled or emergency caesarean section were included. Results: Of 397 caesarean sections, 32 (8.06%) involved parturient with heart disease. The average age was 29 years. Cardiac diseases included rheumatic valvular disease (53.1%), congenital heart disease (21.9%), peripartum cardiomyopathy (15.6%) and coronary artery disease (9.4%). Previous cardiac surgery had been performed in 25% of patients. Of those on curative anticoagulation, only 18% had adequate compliance. Antenatal consultations were well attended by 43.8% of patients. At preoperative assessment, 68.8% were dyspneic, with a mean PAPS of 47 mmHg. Caesarean section was planned in 50% of cases. General anesthesia was preferred in 53.1% of cases. Intraoperative complications included cardiogenic shock (31.3%), cardiac arrest (9.4%, 3 cases) and neonatal resuscitation in 28.1% of cases. The maternal mortality rate was 21.9%. Conclusion: Heart disease in pregnancy remains associated with high morbidity and mortality in low-resource settings, with rheumatic valve disease being the most frequent. Delayed surgical management favors the development of severe pulmonary hypertension, complicating obstetrical management. Better therapeutic education, reinforced prenatal follow-up and wider access to cardiac surgery could improve maternal-fetal prognosis.

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Objective: To study the epidemiological and clinical aspects of stroke. Methodology: A one-year prospective descriptive study conducted at the Gabriel Touré University Hospital Emergency Department on patients diagnosed with stroke. The tools used were SPSS 22.0, Microsoft Word 2021 and Excel software. The Chi-square test is significant if P is ˂0.05. The information was collected anonymously and confidentially. Results: out of 20,001 admissions to the emergency department, 751 patients were diagnosed with stroke (3.7%). The average age was 61.7± 17.5 years, with a sex ratio of 1.39. The majority were traders (33.4%) and lived in urban areas (77%). Transport was provided by taxis (66.7%), with an average time of 11.9±4.9 hours. The most common medical history was high blood pressure (89.5%). Impaired consciousness was the most common reason for consultation (69%). Hemiplegia was the most common clinical sign (46.2%). The Glasgow score on admission was between 13-15 (44.1%) and Glasgow less than 8 (15%). MAP was 160±45 mmHg for IS and 140±35 mmHg for SAH. DTC was performed (40%), confirming ICH (34%). Strokes were ischaemic (56.1%) and haemorrhagic (33.3%). Secondary cerebral attacks of systemic origin were hyperthermia (55%) and hyponatraemia (30%). Complications were pulmonary (50%) and neurological (26.6%). Treatment was medical (75%) and medico-surgical (25%), with systematic rehydration and prevention of stress ulcers. Mortality was 41.2%, with an average hospital stay of 8.1± 6.5 days. Conclusion: Strokes remain a major public health concern. Improving prognosis requires early pre-hospital care with multidisciplinary collaboration and adequate technical facilities.

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Introduction: Renal Failure Represents Approximately 1% Of Emergency Admissions. In Our Setting, The Vast Majority of Chronic Renal Failure Patients Are Under-Dialyzed, And Access to Emergency Extracorporeal Renal Replacement Therapy Is Not Always Available. Objective: To Report the Clinical, Therapeutic, And Evolutionary Characteristics of Renal Failure in the Emergency Department of A Tertiary Hospital in Africa. Patients And Methods: This was a Cross-Sectional Prospective Study from January to December 2024, Including All Patients Presenting with Renal Failure Either at Admission or During Management of Another Condition in The Emergency Department. Results: During The Study Period, 160 Patients Were Diagnosed with Renal Failure, Giving A Prevalence Of 3.55%. The Mean Age Was 50 Years [16,7]. There Was A Male Predominance Of 54.4%. The Main Reasons for Consultation Were: Respiratory Distress 24.38%; Altered Consciousness 23.75%; Infectious Syndrome 12.50%; Arteriovenous Fistula Rupture 5%; Deep Vein Thrombosis 3.13%. A Total Of 33.1% Of Patients Were Known Chronic Renal Failure Patients, and 23% Were on Chronic Dialysis. In Addition, 29.4% Of Patients Were Diabetic, And 59.4% Hypertensive. A History of Nephrotoxic Drug Intake Within the Three Months Prior To Admission Was Found In 30.6% Of Patients. At Admission, 40% Had A GCS < 15; Mean Spo₂ Was 89% [8.4]; Mean MAP Was 102 Mmhg. Mean Hemoglobin Level Was 8 G/Dl [2.5]; Creatinine 627 µmol/L [526]; Sodium 127 Mmol/L [10.46]. Life-Threatening Hyperkaliemia Was Present In 8.8% Of Patients. Oxygen Therapy Was Initiated In 55% Of Patients. Ten Percent Were Transfused. Emergency Renal Replacement Therapy Was Performed In 70% Of Cases. Major Complications Included: Infectious Pneumonia 25.6%; Uremic Coma 8.1%; Hemorrhagic Syndrome 5%; Status Epilepticus 2.6%. Mortality Was 31.3%. Mean Length of Stay Was 6 Days [3.5]. Conclusion: Under-Dialysis Is Responsible for Decompensations and High Mortality.

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Background: Red blood cell (RBC) aggregability and deformability are determining factor of blood viscosity, microcirculatory flow, and oxygenation of tissues. These hemorheological properties can be modified by different pharmacological agents such as anesthetics. This study explored the impact of two widely used anesthetic drugs, ketamine and lidocaine, on aggregability and deformability of the RBCs in male Wistar rats. Methodology: The male Wistar rats (N= 35) were subdivided into five groups of six each. Group 1 was a control which was subjected to distilled water. Group 2 got 2 mg/kg lidocaine (plain), Group 3 got 2mg/kg lidocaine with adrenaline, Group 4 experienced 5mg/kg ketamine and Group 5 had a combination of 5mg/kg ketamine with 2mg/kg lidocaine. The treatments were done on two days. At the termination of treatment rats were sacrificed and blood samples were taken through cardiac puncture. The deformability of the RBCs was determined through diffraction ektacytometry and automated rheoscopy, and the aggregability indices were determined through rheoscopes based on light transmission at rest. Analysis of data was done through ANOVA where the significance was p < 0.05. Results and Discussion: The results indicated that there were no significant changes in RBC aggregability and deformability of all treatment groups against the controls. The ketamine alone or the combination of ketamine and lidocaine had no effect on the erythrocyte rheological behaviour. These findings are in line with the past studies that have shown that these anesthetics have insignificant effects on blood viscosity, hematocrit or plasma rheology. Conclusion: Ketamine and lidocaine do not negatively impact on RBC aggregability and deformability of male Wistar rats. Their application seems to be hemorheologically secure with no threat of causing the blood viscosity and microcirculatory flow disruption.

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Introduction: Admission to intensive care is a source of anxiety and psychological stress for loved ones. This led us to initiate this study, which aimed to investigate the prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) symptoms among relatives of intensive care patients. Materials and Methods: Data collection was prospective over 5 months (July to November) 2024. Anxiety and depressive symptoms were measured using the HADS score. The prevalence of PTSD was assessed using the Impact of Events-Revised Scale (IES-R). Results: Of 293 admissions, 41 families were included. The mean age was 46.1 ± 7.8 years, and the sex ratio was 4.8. Spouses were the majority (31.7%), followed by fathers and mothers (22%); the mortality rate was 22%. The overall prevalence of anxiety was 61%, and depression was 43.9%. Early anxiety was significantly associated with male sex, transference, and spouses. Late anxiety was significantly associated with male sex, transference, and spouses. Early depression was associated with male sex, sons/daughters, and death. Late depression was associated with male sex, spouses, and death. The prevalence of PTSD was 56.1% among relatives and was significantly associated with male sex, education level, spouses, transference, and the occurrence of death. Conclusion: The prevalence of anxiety, depression, and post-traumatic stress was high and associated with male sex, kinship, spouses, transference, and death.

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Introduction: enteral nutrition is a key component of the management of critically ill patients. The objective was to describe the current practices of enteral nutrition support among admitted patients in the polyvalent intensive care units of two university hospitals in Abidjan. Methods: it was a retrospective descriptive study. Socio-demographic, clinical, outcome related and nutritional parameters were analyzed along the biochemical composition of blended fluid feeds. Results: a total of 101 patients (55 in one center and 46 in the other) were included. Men represented 60% and the mean age was 45.69 years. Neurological disorders were the leading cause of admission (78.57%). Nutritional status could not be reliably assessed, as weight and height were recorded in only 62.16% and 16% of patients respectively. Likewise, biological markets of malnutrition risk (albumin, transthyretin and CRP) were not routinely ordered. The mean length of stay was 10.8+- 3.79 days, and mortality was high (69.1%). Conclusion: these findings strongly support the need to implement systematic nutritional assessment ad structured enteral feeding protocols in the ICU with the aim of improving patients’ outcomes.