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: Thoracic surgery frequently requires lung exclusion using a double-lumen probe. While bronchoscopy remains the gold standard for verifying probe placement, its logistical and financial constraints have prompted the exploration of alternatives. Pleuropulmonary ultrasound, by detecting pleural sliding, offers a non-invasive and rapid approach. This preliminary prospective study evaluates the performance of pleuropulmonary ultrasound in predicting lung exclusion. Patients and Methods: Between August and December 2024, 20 adult patients scheduled for thoracic surgery at the Fann University Hospital (Dakar) were included. After intubation with a Carlens tube, exclusion was assessed by clinical auscultation and by lung function testing. The primary outcome was the surgeon's intraoperative assessment (quality of lung collapse). Sensitivity (Se) and positive predictive value (PPV) were calculated for each method. Results: The cohort (mean age 48 years; sex ratio 1.8) had a satisfactory exclusion rate of 100% according to the surgeon. Auscultation identified exclusion in 14 cases (sensitivity 70%), while percutaneous transurethral resection (PUR) confirmed it in 18 cases (sensitivity 90%). The positive predictive value (PPV) was 100% for both techniques. In the absence of exclusion failures, specificity and negative predictive value could not be determined. Conclusion: Pleuropulmonary ultrasound has a higher sensitivity than auscultation for confirming pulmonary exclusion. Although bronchoscopy remains essential in cases of doubt, PPE is proving to be a powerful, reproducible, and accessible complementary tool, enhancing anesthetic safety in thoracic surgery.

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Carotid artery lesions are a major cause of ischemic stroke. General anesthesia for carotid endarterectomy requires costly neurological monitoring, which is often unavailable in certain settings, such as that of this study. This work evaluates the feasibility and benefit of ultrasound-guided regional anesthesia (RA) combining intermediate and superficial cervical plexus blocks. This was a prospective descriptive study conducted over 13 months, including 9 patients. The RA technique, under ultrasound guidance, combined a pericarotidial infiltration, an intermediate cervical block, and a superficial block with cutaneous infiltration, using 0.5% bupivacaine. The primary endpoint was the quality of the sensory block. RA was complete in 89% of the tested territories. Additional sedation-analgesia was required for 3 patients (33%). No serious complications occurred. Minor adverse effects (cough, hoarseness) were transient. Postoperative analgesia was satisfactory. In conclusion, this combined ultrasound-guided block is a viable and safe alternative to general anesthesia for carotid surgery in resource-limited settings, allowing for continuous clinical neurological monitoring. The choice of technique should be individualized.

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Background: Immobility in the intensive care unit contributes to significant complications, including ICU-acquired weakness (ICUAW), prolonged mechanical ventilation, and extended hospitalization. Early physiotherapy is increasingly adopted to counteract these adverse effects. This study aimed to characterize PT utilization, interventions, and its impact on respiratory, functional, and clinical outcomes in a mixed medical-surgical ICU. Methods: We conducted a prospective observational study over nine months in a tertiary care ICU. All adult patients admitted to the ICU were screened. We enrolled 78 consecutive patients who received a formal PT request. Data collected included patient demographics, clinical characteristics, admission diagnoses, timing of PT initiation, specific interventions, and key outcomes. Outcomes were compared between an "Early PT" group (initiated ≤72 hours of admission) and a "Late PT" group (>72 hours). Results: out of 504 patients admitted to the ICU during the study period, 78 (15.5%) received a PT request. The mean age of the cohort was 61±12 years. The mean time to PT request was 48±24 hours. The Early PT group (n=45) demonstrated a significantly higher rate of successful early extubation (within 72 hours of intubation) compared to the Late PT group (n=33) (75.0% vs. 43.8%, p=0.021). The incidence of severe ICUAW (MRC sum score <48) was substantially lower in the Early PT group (17.8% vs. 45.5%, p=0.006). Consequently, the mean ICU length of stay was significantly shorter for patients receiving early PT (8.8±3.1 days vs. 13.0±6.5 days, p=0.001). Conclusion: Early PT intervention in critically ill patients is associated with significant improvements in clinical outcomes, including higher rates of successful early extubation, a marked reduction in the incidence of severe ICUAW, and a shorter ICU length of stay.

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Background: Transverse colon surgery is technically demanding because of the anatomical mobility of the colon and its complex vascular supply. In sub-Saharan Africa, late presentation and emergency conditions remain frequent, but dedicated data on transverse colon surgery are scarce. Objective: To describe the indications, surgical procedures and postoperative outcomes of transverse colon surgery in four referral hospitals of Douala, Cameroon. Methods: We conducted a retrospective multicenter descriptive study over a 10-year period (January 2012–December 2021). All patients who underwent surgery involving the transverse colon were included. Sociodemographic characteristics, operative indications, surgical procedures and in-hospital postoperative outcomes were analyzed descriptively. Results: A total of 103 patients were included. Mean age was 44.68 ± 27.63 years (range: 7 months–83 years), with male predominance (sex ratio 2.4). Emergency surgery accounted for the majority of cases. Acute generalized peritonitis was the leading indication (33.0%), followed by intestinal obstruction (22.2%) and abdominal trauma (17.4%). Right hemicolectomy (41.4%) and transverse colectomy (35.9%) were the most frequently performed procedures. Postoperative complications occurred in 18.4% of patients, dominated by surgical site infections (13.6%). In-hospital postoperative mortality was 3.9%. Conclusion: Transverse colon surgery in Douala is predominantly performed in emergency settings and is associated with a substantial burden of postoperative infectious morbidity. Improving early diagnosis and perioperative care is essential to improve outcomes.

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Introduction: Enhanced recovery after cesarean (ERAC) delivery is a multimodal approach aimed at reducing surgical stress and accelerating maternal recovery after cesarean. Its application remains limited in many African contexts. This study evaluated the application and results of an ERAC protocol in an hospital of sub-Saharan Africa. Patients and Methods: this is a prospective, descriptive and analytical study conducted over 5 months. Fifty patients who underwent a caesarean section under spinal anesthesia and met the inclusion criteria were analyzed. The data was collected from obstetric records, anesthesia registers and interviews with patients. The variables included demographic, per and postoperative clinical parameters as well as maternal feeling and satisfaction. The analyses were performed with STATA with a significance threshold p<0.05. Results: The average age of patients was 27.2 years. The majority of caesarean sections were scheduled (82%) and performed for scarring of the uterus (44%) or fetal and adnexal pathologies (30%). All patients benefited from effective multimodal analgesia, an early mobilization and feeding protocol. Immediate skin-to-skin contact was established in 96% of patients. Postoperative pain was well controlled with a VAS < 3 at rest in 84% of patients. Overall maternal satisfaction was high in 92% of parturients. The most common adverse events were postoperative nausea vomiting (34.6%) but did not compromise the benefits of the protocol. The average length of stay was 57 hours. Conclusion: The implementation of the ERAC protocol in sub-Saharan Africa is feasible and well accepted by patients. It promotes rapid recovery, pain control and strong maternal satisfaction. Enhanced staff training could optimize the application of the protocol.

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Introduction: Hemorrhagic stroke is a major cause of death and disability in low-resource settings. The objective of this study was to describe the epidemiological, clinical, therapeutic, and prognostic features of hemorrhagic stroke patients managed in the Emergency Department (ED). Methods: We conducted a prospective descriptive and analytical study in the ED of CHU Gabriel Touré over a 12-month period. We included all patients presenting with a focal neurological deficit without head trauma and with CT-confirmed hemorrhagic stroke. Data were collected using a standardized form and analyzed with SPSS version 22. Categorical variables were compared using the chi-square test or Fisher’s exact test as appropriate, and relative risks were calculated. Statistical significance was set at p < 0.05. Results: Among 751 stroke cases, 224 hemorrhagic strokes were recorded, accounting for 29.8% of all strokes. The mean age was 53.7 years, with a male predominance (62%). Hypertension was the main risk factor (77.4%). The most frequent reasons for admission were motor deficit (79.3%) and altered level of consciousness (73%), with abrupt onset in 91.1% of cases and admission within 6 hours in 65.2%. CT imaging showed intracerebral (intraparenchymal) hemorrhage in 60.7% of patients. Intensive supportive care was common (intubation 45.5%, oxygen therapy 78.1%), and 18.8% underwent neurosurgical management. The leading complications were aspiration pneumonia (76.9%) and intracranial hypertension (50.8%). In-hospital mortality was 44.6% and was significantly associated with severe prognostic scores (ICH ≥ 3), impaired consciousness, intracranial hypertension, ventilator-associated pneumonia, and malaria. Conclusion: Hemorrhagic stroke affected predominantly relatively young adults and was associated with high in-hospital mortality. Strengthening hypertension prevention and control, reducing pre-hospital delays, and improving access to intensive and neurovascular care are essential t