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2. Study of the Management of Children with Major Sickle Cell Disease in Pediatric Emergencies at the Gabriel Toure University Hospital

Author

Mohamed Elmouloud Cissé, Abdoul Aziz Diakité, Adama Dembélé, Belco Maiga, Fatoumata Nampomo Diarra, Oumar Coulibaly, Hawa Diall, Pierre Togo, Abdoul Karim Doumbia, Abdoulaye Barry, Karamoko Sacko, Fousseyny Traore, Djeneba Konaté, Kalirou Traoré, Lala N’Drainy Sidibé, Ibrahim Ahamadou, Amadou Touré, Fatoumata Dicko, Boubacar Togo, and Mariam Sylla

Subjects
General Medicine
Published
2023
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3. Systemic Lupus Erythematosus Complicated by Pericarditis: A Case Report from the Guindo Clinic in Bamako, Mali

Author

Kalirou Traoré, Karamoko Sacko, Souleymane Mariko, Belco Maiga, Hawa Konaré, Adama Dembélé, Mohamed Cissé, Fousseyni Traoré, Ibrahim Dollo, Fatoumata Traore, Arouna Ouattara, Aminata Doumbia, Mamadou Traore, Djeneba Konate, Pierre Togo, Abdoul Karim Doumbia, Gassama Diaby, Abdoul Aziz Diakité, Ali Guindo, Fatoumata Dicko, Mariam Sylla, and Boubacar Togo

Subjects
General Medicine
Published
2023
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6. Management of an Intra-Orbital Tumor with Maxillary and Nasal Infection at the Nianankoro Fomba Hospital in Segou: About a Case

Author

B. M. Dramé, M. A. Togo, A. Singupiré, H. Toungara, A. N. Coulibaly, T. Traoré, A Bah, A. Kassogué, S. I. Koné, D. S. Coulibaly, B. Samaké, M. Keita, A. Sanogo, A. Kodio, T. B. Bagayoko, O. Koné, and M. Diallo

Subjects
General Medicine
Abstract

The tumor of the orbital region is defined as a progressive and abnormal increase in the volume of the orbit, its contents or as a progressive, abnormal and simultaneous increase in the volume of these two structures, due to an excessive multiplication of tumor cells leading to a exophthalmos. The objective of this work is to study the clinical, paraclinical and therapeutic aspect of this lesion, and to identify the histological type of the tumor. It was Mrs. AD mother of a child, aged 19, with no known medical and surgical history; admitted on September 28, 2022 to the stomatology and maxillofacial surgery department of the Nianankoro Fomba hospital in Ségou for right ocular exophthalmos accompanied by pain and visual disturbance. Surgical treatment consisted of orbital exenteration, avoiding recurrences and postoperative superinfections and restoring the aesthetics of the face. The cytology result of the surgical specimen reveals a moderately differentiated sarcoma. Facial region tumors are lesions that aesthetically affect patients. Their prognosis and therapeutic follow-up after surgery depend on the histological type confirmed by cytological examination of the surgical specimen.

Published
2023
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7. Evaluation of the quality of prenatal consultation at the Community Health Center of Ber in the Health District of Tombouctou

Author

Kanthé D, Koné O, Samaké Y, Cissé K, Fomba D, Giani S, Dembélé BT, and Togo P

Subjects
General Medicine
Abstract

The aim was to evaluate the quality of the prenatal consultation at the Community Health Center of Ber, in the Health District of Tombouctou. Patients and Methods: Descriptive cross-sectional study with analytical aim including an observational flight, a quantitative component with exhaustive sampling and a qualitative component following a reasoned non-probabilistic sampling involving 347 pregnant women and which took place over 45 days from November 15 to December 31, 2019 at the Ber CSCom in the Tombouctou Health District. Results: The age group was between 24 and 33 years old with 48.4%. The majority of users of SR services and care consulted for a CPN1 with 70%. 58.8% had a history of multiparty. Only 12.4% of the pregnancies monitored were identifiedas at risk. 0.6% of the users presented danger signs. The majority of users received a MILD with a rate of 65.4%.The qualitative study allowed us to know the knowledge, attitudes and practices of mothers, grandmothers, women leaders, ATR and men on CPN. The observational study allowed us to evaluate the reception, the quality of the care, the profile of the staff and the availability of medicines, the caregiver-caregiver relationship. Conclusion: The performance of the CPN services at the Ber CSCom was judged satisfactory according to the rating parameters used in the present study. It should be optimal to allow all pregnant women and users to benefit from it.

Published
2023
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8. Acute Appendicitis at the Markala’s Reference Health Center about One Hundred and Three Cases

Author

Kanthé D, Koné O, Fomba D, Dembélé B T, Samaké Y, Kéita M, Samaké B, Bagayoko T B, and Togo A P

Subjects
General Medicine
Abstract

The aim is to study acute appendicitis in the surgery department of the Markala Reference Health Center. Patients and Methods: We conducted a retrospective study in the general surgery department of the reference health center which took place over a period of 35 months from October 1, 2019 to October 30, 2021. The retrospective period was from the month of October 2019 in October 2020 then follows the prospective period until October 2021. Inclusion criteria: Were included in our study; all patients with appendicitis or its complicated forms in the general surgery department of the Csréf in Markala. Non-inclusion criteria: Were not included in our study; cases of appendicitis outside the general surgery department of the Csréf. -Appendicitis accounted for 58.2% of hospitalizations or 31% of emergency surgeries performed during the study period. 85.4% of the patients were without medical-surgical ATCD, on the other hand the oldest of our patients was 61 years old; the average age was 29 years old and the youngest was 13 years old. Furthermore, we note that there was no age of onset of appendicitis. The treatment received by all of our patients was appendectomy (93 cases were operated on urgently and the 10 cases were first cooled and then operated on 3 months after the medical treatment). No major complication was noted in our patients, apart from three cases of infection of the surgical site related to the fact that it was an appendicular abscess. Conclusion: Acute appendicitis is one of the most common surgical emergencies in digestive surgery. Its diagnosis is essentially clinical, sometimes made difficult by the absence of anatomo-clinical parallelism linked to the polymorphism of the lesions and the variations in the position of the organ in the abdominal cavity. Untreated, it can progress to serious complications (generalized peritonitis). It is a condition with low morbidity and mortality subject to early diagnosis and surgical treatment.

Published
2023
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9. Neonatal and Infant-Juvenile Morbidity in African Hospitals: The Case of Commune II of the District of Bamako

Author

Chaka Keita, Kadiatou Ba, Sidi Toure, Boubacar Niare, Salia Ouonogo, Fatoumata Sylla, Zoumana Samake, Hachimi Poma, Samou Diarra, Hawa Coulibaly, Kassim Ouattara, Bakary Abou Traore, Salif Djiguiba, Abdramane Traore, Oumar Diallo, Adama Dembele, and Boubacar Togo

Subjects
General Medicine
Abstract

Introduction: Neonatal and child morbidity is a threat to socio-economic and health progress in sub-Saharan Africa. In paediatric in-patient practice, knowledge of morbidity is important for health care personnel to ensure optimal patient management. The frequency of these pathologies varies between countries. Objective: The objective of our study was to identify the main morbidities in children hospitalised in the paediatric ward of the commune II health centre. Methods: This was a retrospective descriptive study from 1 January to 31 December 2017. We included all children aged 01 month to 15 years hospitalized in the pediatric ward. The study included 418 children aged 0 to 15 years hospitalised in the department during the study period. Results: Children aged 0 to 5 years were the most represented 89.4% with a majority in the 0 to 1 month age group (39%). Males were the most represented with 58%, i.e. a M/F sex ratio of 1.4. ). The children's mothers were not in school in 78% of cases and were housewives in 70%, and 95% of the parents were married. Socioeconomic status was very low in 34% of families. The patients consulted after 1 to 2 days in 47.1% of cases. Admission to the service was direct in 84% and hospitalisation was more frequent between July and November in 66.3%. The reasons for hospitalization of children were dominated by fever 39% followed by respiratory difficulties 29% and convulsions 10%. Malaria was the first cause of hospitalization with 30%.

Published
2023
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11. Hematocolpos Secondary to an Unrecognized Diagnosis of Hymenial Imperforation: A Case Report and Review of the Literature

Author

Seydou Mariko, Brahima Bamba, Amaguiré Saye, Pierre Coulibaly, Nanko dit Seydou Bagayogo, Bréhima Traoré, Mamadou Haidara, Alou Samaké, Abdramane Togo, Mamadou B Coulibaly, Alassane Traoré, Alpha Gakou, and Souleymane Sidibé

Subjects
General Medicine
Abstract

A relatively rare congenital malformation, hematocolpos is the progressive accumulation of menstrual blood in the vaginal cavity at puberty. It is often the consequence of a hymen imperforation. It is clinically manifested by cyclic pelvic pain and primary amenorrhea and, more rarely, by a pelvic mass syndrome. The diagnosis is primarily clinical. Ultrasound and magnetic resonance imaging (MRI) are additional tests to confirm hematolcolpos and exclude other associated genitourinary malformations. Treatment consists of a hymenotomy to drain the hematocolpos. The age of discovery of hematocolpos varies from 13 to 14 years. We report a case of hematocolpos secondary to hymenal imperforation diagnosed in a 17-year-old girl with periodic pelvic pain, primary amenorrhea and a pelvic mass. A first ultrasound trap had evoked a large ovarian cyst but the repeat pelvic ultrasound in our hospital confirmed the diagnosis of hematocolpos.

Published
2023
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12. Epidemioclinical Profile and Immediate Outcome of Low Birth Weight at the Reference Health Center in Commune VI of the District of Bamako, Mali

Author

Mariam Maiga, Oumar Coulibaly, Mariam Traore, Hibrahima Diallo, Korotoumou W. Diallo, Bourama Kane, Alou Samake, Mamadou Diallo, Moussa Konate, Mamadou Keita, Mohamed Saydi Ag Med Elmehdi Elansari, Diarra Sidy Moctar, Mamadou Traore, Djibril Kassogue, Kadiatou Ba, and Pierre Togo

Subjects
General Medicine
Published
2023
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13. Corneal Blindness Caused by Accidental Ocular Use of Chlorhexidine (Hexz) Gel in Two Newborn Born in the Health District of Kati in Mali

Author

Kadiatou Ba, Moro Sidibe, Bakary Danfaga, Sadio Cissoko, Aichata Tall, Oumar Diallo, Assiatou Simaga, Nouhoum Guirou, Abdoulaye Napo, Adama Dembele, Abdoulaye Nouhoum Coulibaly, Aoua Ibrahima Toure, Mamadou Adama Togo, Chiaka Sanogo, Seydou Bakayoko, Fatoumata Sylla, Lamine Traore, and Sanoussi Bamani

Subjects
General Medicine
Published
2023
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14. Meningioma of the Optical Nerves in a Case at the Hospitalier Center of Saint Denis in Ile de France

Author

Adama Dembele, Moro Sidibe, Ibrahim Conaré, Mamadou Kolé Sidibé, Larcheveque Florence, Seror Julien, Abdoulaye Napo, Daouda Goita, Oumar Diallo, Djonny Jonas Dembele, Mamadou Adama Togo, Kadiatou Ba Koita, Abdoulaye Nouhoum Coulibaly, Cheick Fantamady Tounkara, Nouhoum Touré, Abdoulaye Konaté, Jeannette Traore, Sanoussi Bamani, Lamine Traoré, and Japhet Popanou Théra

Subjects
General Medicine
Published
2023
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15. Post-Panaris Necrosating Fasciitis of the Right Upper Limb in a Case Observed at the Markala Reference Health Center

Author

Kanthé D, Koné O, Samaké Y, Fomba D, Dembélé B T, Dembélé M, Togo A P, Bagayoko T B, Samaké B, and Keita M

Subjects
General Medicine
Abstract

Necrotizing fasciitis is an infection of the skin and deep subcutaneous tissues, spreading along the fasciae and adipose tissue, mainly caused by Group A streptococcus (Streptococcus pyogenes) but also by other bacteria such as Vibrio vulnificus, Clostridium perfringens or Bacteroides fragilis. Objective: To report a case of Necrotizing Fasciitis received at the Markala Reference Health Center. Clinical observation: It was a 45-year-old rice farmer with no known medical-surgical history received for an extensive wound on the right upper limb evolving for three months with impaired general condition and consciousness. The onset of the symptomatology dates back to about 3 months marked by a paronychia of the pulp of the right thumb extended secondarily to the right forearm. The physical examination finds an extensive necrotic wound of the right upper limb presenting voluminous blisters of brown color with a black background filled with purulent and smelly serosities. The diagnosis of Necrotizing Fasciitis was strongly suspected due to the presence of Pyogenic Streptococcus (Sensitive to gentamycin and Amoxicillin) in the pus sample. The patient was therefore put on antibiotic therapy combining Clavulanic acid at a rate of 2g x 3 per day and gentamicin at a rate of 160 mg per day with wide excision of necrotic tissues under general anesthesia in the operating room followed by a daily dressing with 30V hydrogen peroxide and Polyvidone iodine. The evolution was very favorable with a directed healing on D16. Conclusion: Necrotizing fasciitis is distinguished by its increasingly increasing and worrying frequency, its clinical severity and its detrimental character from a functional and vital point of view, which is why its management must be early.

Published
2023
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16. Ovarian Fibrothecoma: A Case Report

Author

Keita, M, Traoré, B. Z, Dembélé, K. S, Kassogué, A, Samaké, B, M. A. Togo, A. N. Coulibaly, Koné, S. I, Dramé, M. B, Traoré, T, Coulibaly, D. S, Bagayoko, T. B, Sanogo, A, Kodio, A, Bah, A, and Toungara, H

Subjects
General Medicine
Abstract

Introduction: Fibrothecal group tumours are part of the gonadal stromal and sex cord tumours (GSST) and represent 1-4.7% of all organic ovarian tumours and are usually benign. We felt it important to report a case in order to share our experience in the management of fibrothecal tumours of the ovary. Observation: This was a 51-year-old postmenopausal patient who was referred to the hospital for abdominal pain in the context of an abdominal mass. A clinical examination and abdominal ultrasound concluded that the left ovarian tumour was benign. A left annecxectomy was performed and the histological examination concluded that the tumour was benign. No tumour marker was measured and no CT scan was performed. The postoperative course was simple and the patient was followed for 3 months.

Published
2023
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17. Effects of clazosentan on cerebral vasospasm–related morbidity and all-cause mortality after aneurysmal subarachnoid hemorrhage: two randomized phase 3 trials in Japanese patients

Author

Hidenori, Endo, Yasushi, Hagihara, Naoto, Kimura, Katsumi, Takizawa, Kuniyasu, Niizuma, Osamu, Togo, and Teiji, Tominaga

Subjects
Treatment Outcome, Japan, Humans, Vasospasm, Intracranial, Cerebral Infarction, General Medicine, Subarachnoid Hemorrhage, Morbidity
Abstract

OBJECTIVE Clazosentan has been investigated globally for the prevention of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH). The authors evaluated its effects on vasospasm-related morbidity and all-cause mortality following aSAH in Japanese patients. METHODS Two similar double-blind, placebo-controlled phase 3 studies were conducted in 57 Japanese centers in patients with aSAH, after aneurysms were secured by endovascular coiling in one study and surgical clipping in the other. In each study, patients were randomly administered intravenous clazosentan (10 mg/hr) or placebo (1:1) starting within 48 hours of aSAH and for up to 15 days after aSAH. Stratified randomization based on World Federation of Neurosurgical Societies grade was performed using a centralized interactive web response system. Vasospasm-related morbidity and all-cause mortality within 6 weeks post-aSAH, including new cerebral infarcts and delayed ischemic neurological deficits as well as all-cause mortality, were the first primary endpoint in each study. The second primary endpoint was all-cause morbidity (new cerebral infarct or delayed ischemic neurological deficit from any causes) and all-cause mortality (all-cause morbidity/mortality) within 6 weeks post-aSAH. The incidence of individual components of the primary morbidity/mortality endpoints within 6 weeks and patient outcome at 12 weeks post-aSAH (including the modified Rankin Scale scores) were also evaluated. The above analyses were also performed in the population pooled from both studies. RESULTS In each study, 221 patients were randomized and 220 were included in the full analysis set of the primary analysis (109 in each clazosentan group, 111 in each placebo group). Clazosentan significantly reduced the incidence of vasospasm-related morbidity and all-cause mortality after aneurysm coiling (from 28.8% to 13.6%; relative risk reduction 53%; 95% CI 17%–73%) and after clipping (from 39.6% to 16.2%; relative risk reduction 59%; 95% CI 33%–75%). All-cause morbidity/mortality and poor outcome (dichotomized modified Rankin Scale scores) were significantly reduced by clazosentan after preplanned study pooling. Treatment-emergent adverse events were similar to those reported previously. CONCLUSIONS Clazosentan significantly reduced the combined incidence of vasospasm-related morbidity and all-cause mortality post-aSAH with no unexpected safety findings. Clinical trial registration nos.: JapicCTI-163368 and JapicCTI-163369 (https://www.clinicaltrials.jp)

Published
2022
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18. Giant Parotid Tumor at Nianankoro Fomba Hospital in Ségou: About a Case

Author

B. M. Dramé, B. Samaké, M. Keita, A. N. Coulibaly, M. A. Togo, T. B. Bagayoko, T. Traoré, A. Bah, A Kassogué, S. I. Koné, H. Toungara, D. S. Coulibaly, A. Sanogo, and A. Kodio

Subjects
General Medicine
Abstract

Parotid tumor is defined as a progressive and abnormal increase in the volume of the parotid due to an excessive multiplication of cells. The diagnosis of tumors is pre, per and postoperative. The treatment is mainly surgical. The objective of this work was to bring out the clinical, para-clinical and therapeutic aspect of parotid tumors. It was Mr D M of Malian nationality, 55 years old, admitted to the stomatology/maxillofacial surgery department of the Nianankoro Fomba hospital in Ségou for treatment of swelling of the right hemiface. The observation of this case relates to a 55-year-old patient who is compatible with the age group of the study conducted by E.S. Diom et al., The average age of the patients was 40 years with extremes of 5 years and 80 years [1]. Parotid tumors are mixed tumors. The latent nature of some of them sometimes makes us see long evolutions, voluminous forms which can evolve into cancerous forms.

Published
2022
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19. A single administration of barley β-glucan and arabinoxylan extracts reduces blood glucose levels at the second meal via intestinal fermentation

Author

Kento Mio, Marina Togo-Ohno, Natsuki Tadenuma, Reina Ogawa, Chiemi Yamanaka, and Seiichiro Aoe

Subjects
Organic Chemistry, General Medicine, Molecular Biology, Applied Microbiology and Biotechnology, Biochemistry, Analytical Chemistry, Biotechnology
Abstract

Diet with barley may suppress the glycemic response after consuming the next meal (“second meal effect”). This study aimed to investigate the second meal effect and its mechanism. Mice were given a single dose of β-glucan or arabinoxylan, the primary sources of soluble fiber in barley. A single dose of β-glucan or arabinoxylan extract, followed 6 h later by a 20% glucose solution (second meal), suppressed blood glucose elevation. Arabinoxylan and β-glucan increased the levels of short-chain fatty acids (SCFAs) in the ileum and cecum, respectively. Total GLP-1 secretion in the blood increased with β-glucan and showed an increasing trend with arabinoxylan. These results suggest barley β-glucan and arabinoxylan are fermented in the intestinal tract to generate SCFAs, which may induce GLP-1 secretion and control blood glucose levels during the second meal.

Published
2022
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20. A comparison of a SARS-CoV-2 rapid-test and serological-test in a Public Health Hospital

Author

Giovanni Dell’Aversana Orabona, Giulia Togo, Carlo Calvanese, Andrea Ferri, Umberto Committeri, Giovanni Improta, Giorgio Iaconetta, Luigi Califano, Dell'Aversana Orabona, Giovanni, Togo, Giulia, Calvanese, Carlo, Ferri, Andrea, Committeri, Umberto, Improta, Giovanni, Iaconetta, Giorgio, and Califano, Luigi

Subjects
Rapid test, Hospitals, Public, SARS-CoV-2, COVID-19, General Medicine, Public, Antibodies, Viral, asymptomatic subject, Microbiology, Antibodies, Hospitals, Infectious Diseases, Serological test, Virology, Serologic Test, Antibody response, Humans, Serologic Tests, Parasitology, Viral, Public Health, Asymptomatic subjects, Human
Abstract

Introduction: Nowadays, with the start of the vaccination campaign is very important to assess the extent of exposure of the population and identifying rapid, sensitive and accurate test to quickly identify new cases of SARS-CoV-2. The rapid test, cheap and easy to perform, is therefore very useful in developing countries, where the vaccination campaign has not yet reached adequate coverage. Methodology: We compared the VivaDiag COVID-19 IgM/IgG Rapid Test (VivaCheck Biotech Co., Ltd) with the Roche Elecsys Anti-SARS-CoV-2 (Roche Diagnostics, Rotkreuz, Switzerland) to recognize past infections and to compare VivaDiag COVID-19 IgM/IgG Rapid Test (VivaCheck Biotech Co., Ltd) with Abbott Real Time PCR SARS-CoV-2 assay to recognize infection during its acute phase so that it’s possible to evaluate the use of commercially available assays in clinical practice. Results: Of the 1,100 patients tested with serological and rapid test, 1,085 were negative both to serological and rapid test, 4 patients were positive at rapid (2 for IgM and 2 for IgG) but negative serological test, 11 patients were positive at serological test but negative to rapid. Of the 300 tested with oropharyngeal swab and rapid test, 294 were negative both to swab and rapid test, 2 positives both to swab and rapid test, 3 positives at swab but negative at rapid test, 1 negative at swab but positive at rapid test. Conclusions: the combined use of these tests according to the specific needs of users, allows a reliable identification of infected patients in the acute phase, distinguishing them from subjects with an antibody response from a previous infection.

Published
2022
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22. Tuberculosis in Children: Epidemio-Clinical Aspects in the Paediatric Department of the Gabriel Touré University Hospital Center

Author

Adama Dembélé, Abdoul Aziz Diakité, Mohamed Elmouloud Cissé, Bassirou Diarra, Belco Maïga, Issa Sanou, Pierre Togo, Abdoul Karim Doumbia, Oumar Coulibaly, Karamoko Sacko, Djéneba Konaté, Hawa Diall, Lala Ndrainy Sidibé, Bréhima Dégoga, Fatoumata Léonie Diakité, Guédiouma Dembélé, Fatoumata Dicko, Mariam Sylla, and Boubacar Togo

Subjects
General Medicine
Published
2022
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23. Epidemiologic Features of the First Flare of Ne-phrotic Syndrome in Children in Bamako Pedi-atric Hospitals

Author

Djeneba Konaté, Lala Ndrayni Sidibé, Amadou Touré, Adama Fomba, Abdoul Karim Doumbia, Karamoko Sacko, Aminata Doumbia, Oumar Coulibaly, Mohamed Elmouloud Cissé, Pierre Togo, Adama Dembélé, Awa Konaré, Belco Maiga, Harber Balilé, Fatoumata Léonie Françoise Diakité, Fousseyni Traoré, Hawa Gouro Diall, Ibrahima Ahamadou, Guédiouma Dembélé, Abdoul Aziz Diakité, Fatoumata Dicko Traoré, and Boubacar Togo

Subjects
General Medicine
Published
2022
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24. Epidemiological and Clinical Aspects of Abnormal Movements in Children from 2 Months to 15 Years in the Pediatric Department of Gabriel Toure University Hospital Centre of Bamako

Author

Karamoko Sacko, Djeneba Konaté, Amadou Touré, Belco Maiga, Fousseyni Traoré, Adama Dembelé, Pierre Togo, Abdoul Karim Doumbia, Andoule Guindo, Rokia Togola, Oumar Coulibaly, Diakite Fatoumata Léonie Francois, Ibrahima Ahamadou, Kalirou Traoré, Abdoul Aziz Diakité, and Boubacar Togo

Subjects
General Medicine
Published
2022
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25. Congenital Heart Disease in Newborns: Epidemiological and Clinical Particularities in a Neonatology Department in Mali

Author

Abdoul Karim Doumbia, Oumou Koné, Adama Dembélé, Noumou Sidibé, Noel Banou, Hawa Gouro Diall, Pierre Togo, Oumar Coulibaly, Karamoko Sacko, Djéneba Konaté, Tati Simaga Lala Ndrainy Sidibé, Fatoumata Léonie Diakité, Boubacar Diarra, Guédiouma Dembélé, Belco Maïga, Mohamed Elmouloud Cissé, Hawa Konaré, Aminata Doumbia, Ibrahim Ahamadou, Abdoul Aziz Diakité, Fatoumata Dicko Traoré, and Boubacar Togo

Subjects
General Medicine
Published
2022
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26. Epidemiological and Clinical Aspects of Congenital Hydrocephalus in the Neonatal Department of Gabriel Touré Teaching Hospital Bamako Mali

Author

Hawa G. Diall, Oumar Coulibaly, Youssouf Sogoba, Hatouma Sylla, Yacouba A. Coulibaly, Fatoumata L. Diakité, Lala N. Sidibé, Ibrahima Ahamadou, Leyla Maiga, Abdoul K. Doumbia, Pierre Togo, Adama Dembélé, Mohamed E. Cissé, Fousseini Traoré, Belco Maiga, Karamoko Sacko, Djeneba Konaté, Bourama Kané, Oumou Koné, Guedjouma Dembélé, Abdoul A. Diakité, Drissa Kanikomo, Fatoumata D. Traoré, Mariam Sylla, and Boubacar Togo

Subjects
General Medicine
Published
2022
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27. Childhood Idiopathic Nephrotic Syndrome: A Single-Center Hospital Study

Author

Abdoul Karim Doumbia, Tati Simaga, Adama Dembélé, Mahamadou Salihou Baldé, Hawa G. Diall, Pierre Togo, Aminata Doumbia, Belco Maiga, Karamoko Sacko, Fatoumata Léonie Diakité, Oumou Koné, Oumar Coulibaly, Ibrahim Ahamadou, Mohamed Elmouloud Cissé, Guédiouma Dembelé, Fousseyni Traoré, Hawa Konaré, Amadou Touré, Djènèba Konaté, Lala N’Drainy Sidibé, Leyla Maiga, Abdoul Aziz Diakité, and Boubacar Togo

Subjects
General Medicine
Published
2022
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28. Pulmonary Complications in Children with Sickle Cell Disease Followed at the Pediatric Department of Gabriel Toure University Hospital

Author

Mohamed E. Cissé, Abdoul A. Diakité, Adama Dembélé, Belco Maiga, Pierre Togo, Nicole A. Kpakoutou, Oumar Coulibaly, Karamoko Sacko, Tiaria M. Sanogo, Hawa Diall, Fousseyni Traoré, Abdoul K. Doumbia, Djenèba Konaté, Fatoumata L. Diakité, Ibrahim Ahamadou, Lalla N. Sidibé, Amadou Touré, Fatoumata Dicko-Traoré, Boubacar Togo, and Mariam Sylla

Subjects
General Medicine
Published
2022
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29. Dermal Substitutes and Skin Grafts in the Reconstruction of Post-Traumatic Total Scalp Avulsion: A Case Series

Author

Marzia Petrocelli, Giulia Togo, Silvia Ricci, Flavia Zeneli, Sebastiano Cutrupi, Annamaria Baietti, Paola Bonavolontà, Luigi Califano, Luigi Angelo Vaira, Alfonso Scarpa, Arianna Di Stadio, Giovanni Salzano, Petrocelli, Marzia, Togo, Giulia, Ricci, Silvia, Zeneli, Flavia, Cutrupi, Sebastiano, Baietti, Annamaria, Bonavolonta', Paola, Califano, Luigi, Vaira, LUIGI ANGELO, Scarpa, Alfonso, Di Stadio, Arianna, and Salzano, Giovanni

Subjects
split-thickness skin graft (STSG), dermal substitute, scalp reconstruction, General Medicine, scalp avulsion
Abstract

Although scalp defects can vary in size and thickness, scalp avulsion represents a rare occurrence. This type of lesion may have different origins, but it is usually related to long hair being caught in agricultural machinery. The management of full-thickness scalp defects poses a challenge to the head and neck surgeon due to the possible involvement of neurovascular structures and scar retraction, which can affect the esthetic restoration of the area. Several algorithms for the choice of scalp reconstruction have been proposed in the literature and different techniques are available for extensive scalp defect reconstruction (local soft tissue flap, microvascular free flap, and skin graft combined with dermal substitutes), based upon the scalp defect type. Here we describe six cases of patients with total scalp avulsion, which required a combined reconstruction with a split-thickness skin graft (STSG) and Integra® matrix immediately after the trauma.

Published
2023

30. Atrial Fibrillation in a Patient with Heparin-induced Thrombocytopenia Successfully Treated by Radiofrequency Catheter Ablation Using a Direct Thrombin Inhibitor

Author

Togo, Sakai, Masao, Takemoto, Jiro, Ueno, Eiji, Nyuta, Yoshibumi, Antoku, Tokushi, Koga, and Takuya, Tsuchihashi

Subjects
Male, Sulfonamides, Heparin, General Medicine, Arginine, Thrombocytopenia, Antithrombins, Treatment Outcome, Pipecolic Acids, Atrial Fibrillation, Catheter Ablation, Internal Medicine, Humans, Aged
Abstract

A 74-year-old man was admitted to our hospital to undergo radiofrequency catheter ablation (RFCA) of persistent atrial fibrillation (AF). We found that he had a history of heparin-induced thrombocytopenia (HIT). Thus, a direct thrombin inhibitor, Argatroban Hydrate (Argatroban

Published
2022
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31. Epicardial Connections After a Conventional Pulmonary Vein Antrum Isolation in Patients With Atrial Fibrillation

Author

Eiji, Nyuta, Masao, Takemoto, Togo, Sakai, Yoshibumi, Antoku, Takahiro, Mito, Shintaro, Umemoto, Masaki, Fujiwara, Kaoru, Takegami, Tomohiro, Takiguchi, Miyuki, Nakahara, Tokushi, Koga, and Takuya, Tsuchihashi

Subjects
Treatment Outcome, Heart Rate, Pulmonary Veins, Atrial Fibrillation, Catheter Ablation, Humans, Heart Atria, General Medicine, Cardiology and Cardiovascular Medicine
Abstract

The existence of epicardial connection(s) (ECs) between the pulmonary veins (PVs) and atrium may hinder establishing a complete PV antrum isolation (AI) (PVAI) in patients with atrial fibrillation (AF). Thus, the purpose of this study was to determine the prevalence and location of ECs inside the conventional PVAI lines.Methods and Results: Three-hundred consecutive patients with non-valvular AF were evaluated. This study revealed that: (1) the prevalence of patients with ECs and the number of ECs per patient between the PVs and atrium became significantly greater, respectively, in accordance with the progression of paroxysmal to long-lasting AF and left atrial enlargement; (2) some ECs were located at sites far distal to the PVAI lines; (3) 25% of ECs could be detected only by high-density mapping catheters, but not by conventional circular mapping catheters; (4) a B-type natriuretic peptide (BNP) level of 176.6pg/mL and left atrial volume (LAV) of 129.0 mL may be important predictors of the presence of ECs; and (5) the rate of conduction of ECs from the right PVs was dominantly to the atrium and His-bundle, and that from the left PVs to the coronary sinus was most dominant.The PVAI may not be completed by using only a conventional PVAI method, and additional EC ablation inside the PVAI lines detected using high-density mapping may be able to achieve a more complete PVAI.

Published
2022
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32. Application of the Functionality Transfer Oligodeoxynucleotide for the Site-Selective Modification of RNA with a Divers Molecule

Author

Norihiro Togo, Hirotaka Murase, Jeongsu Lee, Yosuke Taniguchi, and Shigeki Sasaki

Subjects
Azides, Oligodeoxyribonucleotides, Pyridines, Alkynes, Drug Discovery, RNA, General Chemistry, General Medicine
Abstract

Due to the importance of the RNA chemical modifications, methods for the selective chemical modification at a predetermined site of the internal position of RNA have attracted much attention. We have developed functional artificial nucleic acids that modify a specific site of RNA in a site- and base-selective manner. In addition, the copper-catalyzed azide-alkyne cycloaddition (CuAAC) has been shown to introduce additional molecules on the alkynes attached to the pyridine ring. However, it was found that some azide compounds produced the cycloadduct in lower yields. Therefore, in this study, we synthesized the pyridinyl transfer group with the alkyne attached via a polyethylene glycol (PEG) linker with a different length and optimized its structure for both the transfer and CuAAC reaction. Three new transfer groups were synthesized by introducing an alkyne group at the end of the triethylene (11), tetraethylene (12) or pentaethylen glycol linker (13) at the 5-position of the pyridine ring of (E)-3-iodo-1-(pyridin-2-yl)prop-2-en-1-one. These transfer groups were introduced to the 6-thioguanine base in the oligodeoxynucleotide (ODN) in high yields. The transfer groups 11 and 12 more efficiently underwent the cytosine modification. For the CuAAC reaction, although 7 showed low adduct yields with the anionic azide compound, the new transfer groups, especially 12 and 13, significantly improved the yields. In conclusion, the transfer groups 12 and 13 were determined to be promising compounds for the modification of long RNAs.

Published
2022
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34. In Situ Raman Analysis of Biofilm Exopolysaccharides Formed in Streptococcus mutans and Streptococcus sanguinis Commensal Cultures

Author

Giuseppe Pezzotti, Satomi Ofuji, Hayata Imamura, Tetsuya Adachi, Toshiro Yamamoto, Narisato Kanamura, Eriko Ohgitani, Elia Marin, Wenliang Zhu, Osam Mazda, Azusa Togo, Satoshi Kimura, Tadahisa Iwata, Hideki Shiba, Kazuhisa Ouhara, Takashi Aoki, and Toshihisa Kawai

Subjects
Inorganic Chemistry, Streptococcus sanguinis, Streptococcus mutans, cocultures, in situ Raman spectroscopy, biofilm exopolysaccharides, antagonistic interactions, Organic Chemistry, General Medicine, Physical and Theoretical Chemistry, Molecular Biology, Spectroscopy, Catalysis, Computer Science Applications
Abstract

This study probed in vitro the mechanisms of competition/coexistence between Streptococcussanguinis (known for being correlated with health in the oral cavity) and Streptococcusmutans (responsible for aciduric oral environment and formation of caries) by means of quantitative Raman spectroscopy and imaging. In situ Raman assessments of live bacterial culture/coculture focusing on biofilm exopolysaccharides supported the hypothesis that both species engaged in antagonistic interactions. Experiments of simultaneous colonization always resulted in coexistence, but they also revealed fundamental alterations of the biofilm with respect to their water-insoluble glucan structure. Raman spectra (collected at fixed time but different bacterial ratios) showed clear changes in chemical bonds in glucans, which pointed to an action by Streptococcus sanguinis to discontinue the impermeability of the biofilm constructed by Streptococcus mutans. The concurrent effects of glycosidic bond cleavage in water-insoluble α − 1,3–glucan and oxidation at various sites in glucans’ molecular chains supported the hypothesis that secretion of oxygen radicals was the main “chemical weapon” used by Streptococcus sanguinis in coculture.

Published
2023
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35. Petrography and geochemical framework of guébaké dolerites dyke swarms (north Cameroon, central Africa)

Author

Abondou Togo, Nkouandou Oumarou Faarouk, Zangmo Tefogoum Ghislain, Fagny Mefire Aminatou, Daouda Dawai, Dinamou Appoliaire, Guihdama Dagwai Justin, and Adama Haman

Subjects
General Medicine
Abstract

Dolerites dykes of 4.5 to 25 m wide extend from 200m to 1km, crosscut the Guébaké granitoids basement in northern Cameroon along EW to N100E directions. Petrographic studies reveal the microlitic porphyritic texture to classical doleritic texture of ophitic to sub-ophitic types. Guébaké dolerites are mainly composed in various proportions of skeletal plagioclase and feldspar, clinopyxene, amphibole and oxides crystals. ICP-MS and ICP-AES geochemical analyses have distiguished a lava series composed of trachybasalts, basaltic trachyandesites, trachyandesites, trachytes and rhyolites of continentale tholeiites affinity. Lavas have been differenciated trough fractional crystallization process coupled with crustal contamination and metasomatism. Guébaké dolerites are products of relatively high partial melting rate of E-MORB mantle component. They stand as fingerprints of the post pan African crustal consolidation and precursor of the development of central African rift system at Cretaceous times. Â

Published
2022
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36. Trans-Oral Robotic Surgery: 14 Cases of Pleomorphic Adenoma of the Parapharyngeal Space

Author

Giovanni, Salzano, Giulia, Togo, Fabio, Maglitto, Gerardo, Borriello, Francesco, Perri, Giovanni, Audino, Luigi Angelo, Vaira, Maria Grazia, Maglione, Marzia, Petrocelli, Luigi, Califano, and Franco, Ionna

Subjects
Parapharyngeal Space, Robotic Surgical Procedures, Otorhinolaryngology, Head and Neck Neoplasms, Adenoma, Pleomorphic, Humans, Pharyngeal Neoplasms, Surgery, General Medicine, Salivary Gland Neoplasms, Retrospective Studies
Abstract

The aim of this study has been to describe our experience with pleomorphic adenomas of the parapharyngeal space (PPS) treated with trans-oral robotic surgery (TORS). Tumors arising from the PPS comprise less than 0.5% of all head and neck tumors. Salivary gland tumors account for 40% to 50% of PPS lesions with pleomorphic adenomas representing the most common salivary tumors (80%-90%). Parapharyngeal space tumors cause nonspecific symptoms and may be difficult to diagnose.In our study a preoperative diagnosis was conducted by fine needle aspiration biopsy and magnetic resonance imaging and the results were used to plan the correct surgical approach.In all cases we were able to employ TORS, a minimally invasive procedure that allows us to operate in narrow and anatomically complex spaces that we can only reach thanks to the use of well-articulated hand pieces.This report indicates that TORS is a safe surgical procedure for the excision of benign tumors of the PPS in selected cases.

Published
2022
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38. Male Breast Cancer: Diagnostic and Prognostic Features in Mali

Author

Iriss A. Darar, Zakari Saye, Bourama Diarra, Madiassa Konaté, Amadou Traoré, Seydou Pamateck, Abdillahi I. Ismail, Arouna Adama Doumbia, Boubacar Karembé, Bakary Tientigui Dembélé, Lassana Kanté, Drissa Traoré, Zimogo Zié Sanogo, Alhassane Traoré, and Adégné Togo

Subjects
General Medicine
Published
2022
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39. A Novel Approach to Extensive Clarithromycin-Resistant Mycobacterium avium Complex Pulmonary Disease

Author

Kiyomi Shimoda, Kozo Morimoto, Jun Atsumi, Togo T, Miyako Hiramatsu, and Yuji Shiraishi

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, biology, business.industry, medicine.medical_treatment, Gastroenterology, Pulmonary disease, General Medicine, Bronchial occlusion, biology.organism_classification, Surgery, Lingulectomy, Pneumonectomy, Lung disease, Amikacin, Clarithromycin, medicine, Mycobacterium avium complex, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract

A 48-year-old woman with extensive clarithromycin-resistant Mycobacterium avium complex pulmonary disease (MAC-PD) was successfully treated by left lower lobectomy and lingulectomy following combination treatment of intravenous/inhaled amikacin plus bronchial occlusion by Endobronchial Watanabe Spigots (EWSs). A left pneumonectomy was initially indicated for removing all the lesions, but the procedure would have been barely tolerated by the patient. However, her preoperative combination treatment sufficiently reduced the lesions requiring resection to allow surgical preservation of the left upper division. This novel approach might be promising for patients with Mycobacterium avium complex lung disease whose pulmonary reserve will not allow an extensive parenchymal resection.

Published
2022
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47. Neonatal References: Epidemiology and Prognosis in a Malian Context

Author

Adama Koné, Alou Traoré, N. L. Traoré, Abdoul Aziz Diakité, K. Sacko, Guédiouma Dembélé, Leila Maiga, Oumar Coulibaly, F Dicko-Traoré, P Togo, Noel Banou, Fousseyni Traoré, Ibrahim Ahamadou, Hawa Diall, D. Konaté, Djita Ba-Sidibé, L. N. Sidibé, Fatoumata Léonie Diakité, A. Dembélé, B Togo, Belco Maiga, Mariam Sylla, Abdoul Karim Doumbia, and El Mouloud Cissé

Subjects
medicine.medical_specialty, Pediatrics, Referral, Respiratory distress, business.industry, Public health, Context (language use), General Medicine, Odds ratio, Confidence interval, Epidemiology, medicine, Neonatology, business
Abstract

Neonatal mortality remains a public health problem in Mali. The neonatal referral is a systemic factor determining the neonatal prognosis. This work was initiated to determine the frequency of neonatal referrals and to determine their prognosis. Patients and Methods: A cross-sectional study was carried out from November 1, 2019 to January 31, 2020 in the neonatology service of the pediatrics department of the Gabriel Toure University Hospital in Bamako. All newborns referred by another health structure in the country were included in this stud. All newborns referred by another health structure in the country were included in this study. To determine the risk factors related to the neonatal referral, we performed univariate and multivariate analyzes to determine the odds ratios and fitted with a significant p probability if p 0.05 and the 95% confidence interval. Results: The frequency of referrals was 54.3%. Newborns came from basic structures in 19.3% of cases, from tertiary structures in 6.7%. The main reason for transfer was prematurity (40.2%) followed by perinatal anoxia (15.3%), malformations (15.3%), respiratory distress (15.2%) and infection neonatal (9.1%). The ambulance was the primary means of transfer in 71.3%. In 80% of cases the transfer had been made within the first 24 hours of life. On admission, a third of the newborns (31.1%) were less than 1500 g, hypothermic in 43.8% and febrile in 15.1%. The evolution was marked by 40.2% of deaths. The analysis of prognostic factors, allowed us to observe that the more the newborn is premature or of low weight the more risk of death was very high with respectively 18.5 times in the less than 28 weeks of amenorrhea (WA) (ORa = 18.5; CI = 1.9 - 180; p = 0.012) and 6.6 times in those less than 1000g (ORa = 6.6; CI = 1.4 - 29.7; p = 0.015). Likewise, any change in body temperature increased risk of death by 1.9 times compared to normothermia. Conclusion: The establishment of a neonatal referral system is necessary to reduce neonatal mortality in our context.

Published
2021
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48. Seizures in Children under Five in a Pediatric Ward: Prevalence, Associated Factors and Outcomes

Author

O. Kone, Djibril Kassogue, K. Sacko, P Togo, D. Konaté, M Traoré, Fousseyni Traoré, L. N. Sidibé, Guédiouma Dembélé, Adama Bah, Fatoumata Léonie Diakité, A. Dembélé, B Togo, Belco Maiga, Mohamed Elmouloud Cissé, Oumar Coulibaly, Amadou Toure, Abdoul Karim Doumbia, Abdoul Aziz Diakité, and Hawa Diall

Subjects
Pediatrics, medicine.medical_specialty, business.industry, medicine.medical_treatment, Medical record, Retrospective cohort study, General Medicine, medicine.disease, Epilepsy, Oxygen therapy, Convulsion, medicine, Etiology, medicine.symptom, business, Meningitis, Malaria
Abstract

Introduction: convulsion is a frequent cause of neurological and cognitive sequelae and then of epilepsy. The objective of this work was to describe the socio-demographic, clinical, therapeutic, and evolutionary aspects. Methodology: This was a descriptive retrospective study carried out in the general pediatrics department of CHU-Gabriel Toure. It took place over a period of 02 years from January 2017 to December 2018. We included all children aged 1 to 59 months hospitalized in the ward for convulsion. Results: During the study period, 2653 children aged 2 months to 59 months were hospitalized in the general pediatric ward. We included 288 medical records of children who presented with a seizure on admission. Convulsions represented 11% of pediatric hospitalizations from 1 month to 59 months. The average age was 29 months. Fever was present in 86% of patients. The cerebrospinal fluid (CSF) test was positive in 38 patients. Hypoglycemia was present in 14 patients. Serum calcium was low in 3 patients. The most implicated etiologies were malaria 70%, meningitis 20%, and dehydration 13%. Management consisted of airway clearance, oxygen therapy as needed, and administration of diazepam (54%). Antibiotics were prescribed in 77% of cases and antimalarials in 70%. The average length of hospital stay was 8 days with extremes of 1 and 30 days. The outcome was favorable in 95% of cases. Sequelae were observed in 5% of cases and one case of death was observed. Conclusion: Acute convulsions are one of the most common causes of hospitalization in children under 5 years old. The causes were dominated by infectious diseases (malaria, meningitis). The appropriate course of action was the administration of diazepam rectally.

Published
2021
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49. Potential association of eEF1A dimethylation at lysine 55 in the basal area of Helicobacter pylori-eradicated gastric mucosa with the risk of gastric cancer: a retrospective observational study

Author

Yuka, Hirashita, Masahide, Fukuda, Masaaki, Kodama, Yoshiyuki, Tsukamoto, Tadayoshi, Okimoto, Kazuhiro, Mizukami, Yoshinari, Kawahara, Yasuhiro, Wada, Sotaro, Ozaka, Kazumi, Togo, Keisuke, Kinoshita, Takafumi, Fuchino, Kensuke, Fukuda, Kazuhisa, Okamoto, Ryo, Ogawa, Osamu, Matsunari, Koichi, Honda, and Kazunari, Murakami

Subjects
Helicobacter pylori, Stomach Neoplasms, Gastric Mucosa, Lysine, Gastroenterology, Humans, General Medicine, Retrospective Studies
Abstract

Background Although eradication therapy for chronic Helicobacter pylori (H. pylori) reduces the risk of gastric cancer (GC), its effectiveness is not complete. Therefore, it is also critically important to identifying those patients who remain at high risk after H. pylori eradication therapy. Accumulation of protein methylation is strongly implicated in cancer, and recent study showed that dimethylation of eEF1A lysine 55 (eEF1AK55me2) promotes carcinogenesis in vivo. We aimed to investigate the relationship between eEF1A dimethylation and H. pylori status, efficacy of eradication therapy, and GC risk in H. pylori-eradicated mucosa, and to reveal the potential downstream molecules of eEF1A dimethylation. Methods Records of 115 patients (11 H. pylori-negative, 29 H. pylori-positive, 75 post-eradication patients) who underwent upper gastrointestinal endoscopy were retrospectively reviewed. The eEF1A dimethyl level was evaluated in each functional cell type of gastric mucosa by immunofluorescent staining. We also investigated the relationship between eEF1AK55me2 downregulation by CRISPR/Cas9 mediated deletion of Mettl13, which is known as a dimethyltransferase of eEF1AK55me2. Results The level of eEF1A dimethylation significantly increased in the surface and basal areas of H. pylori-positive mucosa compared with the negative mucosa (surface, p = 0.0031; basal, p = 0.0036, respectively). The eEF1A dimethyl-levels in the surface area were significantly reduced by eradication therapy (p = 0.005), but those in the basal area were maintained even after eradication therapy. Multivariate analysis revealed that high dimethylation of eEF1A in the basal area of the mucosa was the independent factor related to GC incidence (odds ratio = 3.6611, 95% confidence interval = 1.0350–12.949, p = 0.0441). We also showed the relationship between eEF1A dimethylation and expressions of reprogramming factors, Oct4 and Nanog, by immunohistochemistry and in vitro genome editing experiments. Conclusions The results indicated that H. pylori infection induced eEF1A dimethylation in gastric mucosa. The accumulation of dimethyl-eEF1A in the basal area of the mucosa might contribute to GC risk via regulation of reprograming factors in H. pylori eradicated-gastric mucosa.

Published
2022
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50. Enhanced postoperative surveillance versus standard of care to reduce mortality among adult surgical patients in Africa (ASOS-2): a cluster-randomised controlled trial

Author

Bruce M Biccard, Leon du Toit, Maia Lesosky, Tim Stephens, Landon Myer, Agya BA Prempeh, Nicola Vickery, Hyla-Louise Kluyts, Alexandra Torborg, Akinyinka Omigbodun, Adesoji Ademuyiwa, Muhammed Elhadi, Mohamed Elfagieh, Bernard Mbwele, Mpoki Ulisubisya, Lazaro Mboma, Daniel Z Ashebir, Mahlet Tesfaye Bahta, Mohammed Hassen, Mikiyas Teferi, Yakob Seman, Eugene Zoumenou, Adam Hewitt-Smith, Janat Tumukunde, Dolly Munlemvo, Atilio Morais, Apollo Basenero, Pisirai Ndarukwa, Nazinigouba Ouerdraogo, Maman Sani Chaibou, Mohyeddine Zarouf, Ahmed Rhassane El Adib, Veekash Gobin, Zimogo Sanogo, Youssouf Coulibaly, Zipporah Ngumi, Tarig Fadalla, Cynthia Iradukunda, Vénérand Barendegere, Isaac O Smalle, Mustapha Bittaye, Ahmadou Lamin Samateh, Mahmoud Elfiky, Maher Fawzy, Wakisa Mulwafu, Vanessa Msosa, Lygia Lopes, Akwasi Antwi-Kusi, Hamza D Sama, Patrice Forget, Dawid van Straaten, Rupert M Pearse, Marichen Puchert, Lucy Rolt, Kris Schwebler, Freddy Kabambi, Tebogo Mabotja, Leandys Cobas, Albino Freitas, Maria Antunes, Bartolomeu Cabo, Domingos Paulo, Carlos Camongua, Yvette Avognon, Osseni Marcos, Raymond Kintomonho, Onesime Demahou, Gisèle Hounsa, Hugues Chobli, Elie Fassinou, Aurore Zoglobossou, Blaise Tchaou, Charles Tchegnonsi, Fifame Amadji, Francine Bossa, Ernest Ahounou, Djima Alao, Roushdane Odérémi, Afissatou Montairou, Oswald Gbehade, Romaric Tobome, Adam Boukari, Patrick Bakantieba, Arouna Sambo, Fanou Lionelle, Nounagnon Gilbert, Julien Attinon, Roger Klikpezo, Aumar Dadjo, Dénis Fanou, Gilberte Hounkpe, Bachabi Fafana, Néné Nguilu, Bodourin Dossou-Yovo, Chantal Segla, Mohamed Toko, Evelyne Gnele-Dedewanou, Michel Noukounwoui, Ethienne Yado, Timothé Gouroubéra, Valéry Adjignon, Serge Mewanou, Aïcha Tchomgang, Urielle Agossou, Fernand Soton, Charbel Azanlin, Lidwine Zomahoun, Rawéléguinbasba Armel Flavien Kabore, Salam Savadogo, Fatou Fleur Rosine Sanou, Farid Belém, Victoria Hien, Cheik Tidiane Hafid W Bougouma, Sie Ahmed Ouattara, Mariam Bambara Kabore, Ouedraogo Nazinigouba, Papougnezambo Bonkoungou, Martin Lankoandé, Mireille Traoré, Patrick Sawadogo, Inès Wenmenga, Boureima Kinda, André Simporé, Christian Sapo, Salah Idriss Traore, Haoua Dipama, Lydie WR Kaboré, Salifou Napon, Télesphore G Kaboré, Arouna Louré, Pélagie PP Tondé, Christian Zoundi, Harouna Sanou, Remy Ndikumana, Carlos Nsengiyumva, Gregory Sund, Alliance Niyukuri, Axel Kwizera, Jean-Claude Niyondiko, Adolphe Manzanza Kilembe, Jean Pierre Mwema Ilunga, Nehema Hailemariam Sarah, Gabriel Mubobo Makeya, Idesbald Mwebe Mwepu, Ted Botawaosenge Likongo, Richard Kapela Mvwala, Raphael Nzau Kapend Mubunda, Noellie Kanka Mukuna, Julie Djondo Pembe, Nicolas Lumuanga Ndaye, Eric Bibonge Amisi, Mike Ilunga Madika, Joe Kembo Lungela, Didier Ndonda Mayemba, Philomene Mamba Diyoyo, Alex Mbo Ngalala, Martin Mamba Mukenga, Patricia Tito Kabuni, Dany Bolimo Mpoto, Herve Inesnku Mole, Louise Keby, Oria Andavo Buti, Anselme Phaka, Belinda Mayenge, Jean Jeacques Kabuley Kalongo, Timothe Kemfuni Mawisa, Rodrigue Tondo Ngwizani, Kuyala Leya, Dieudonne Kisile Sanduku, Timothe Nkemfuni Mawisa, Coco Nseke Mfumu, Mbuta Bolenge, Desire Kinzenzengu Kabuce, Patrick Kintieti, Amelia Mbuluku, Vicky Mahuwa, Tharcice Khonde Mabiala, Guilain Ngoy, Patrick Boloko, Nono Mazangama Mvwama, Jose Kengbanda, Pitchou Mushimbonga, Blaise Kuhapala, Nzosani Marcel, Kienze Guylain, Gerard Mboma, Sandra Zalambo Sagboze, Michel Muteya Manika, Jean Pierre Mumbere Kigayi, Roger Mukanire Cishugi, Placide Buhendwa Mugisho, Roger Baguma, Moïse Kongolo, Michel Mandungu Mbayabu, Crispin Mukendi Muamba, Edmond Banema Kapinga, Vasco Ngolela Kapinga, Guylain Tshimanga Nsumpi, Patrick Kanda Odia, Salomon Bingidimi, Gilbert Kpengbemale, Desire Hubert Bofunga Bosonga Imposo, Patricia Matondo, Servet Lelo, Jeremie Kalambayi, Mohamed Abdel-Ghaffar, Abdelrahman Soliman, Mostafa Abdelrahman, Sameh Shehata, Alia Rabee, Mohamed Abou Heba, Mohamed Rabei Abdelfattah, Tamer Ahmed Maher Ghoniem, Sherif M.K. Shehata, Mohamed Lotfy, Ahmed ElHaddad, Bereket Gebremeskel, Girmay Fisseha, Mebrahtu Abay, Degena Bahrey, Assefa Hika, Abdurezak Ali, Kindie Moges, Jemal Ahmed, Desalegn Abdisa, Abebe Megersa, Wendwosen Abayne, Haftom Berhane, Reiye Esayas, Fitsum Kifle, Kokeb Desita, Abebe Addise, Dagim Shimelash, Shitalem Tadesse, Bezaye Zemedkun, Peniel Kenna, Ayenew Yirdie, Abinet Sisay, Tebikew Gashu, Fassil Mihretu, Yesuf Ahmed, Bekele Debebe, Abdureuf Misgea, Amare Agmas, Rahel Assefa, Abdurahman Gelmo, Seifu Alemu, Brook Damtachew, Merid Mersha, Yaekob Chemere, Samuel Fekadu, Sintayehu Regasa, Bonsa Sileshi, Desalegn Wosen, Rebira Adamu, Gersam Mulugeta, Teshome Bacha, Zewude Gudisa, Kebebe Bekele, Alelign Tasew, Habtamu Gezahegn, Daniel Atlaw, Damtew Solomon, Habtemariam Gebresillasie, Girmaye Tesfaye, Negussie Sarbecha, Biniyam Sahiledengle, Kenbon Seyoum, Gemechu Ganfure, Yohannes Tekalegn, Gosa Tesfaye, Temesgen Ayichew, Shibiru Sendaba, Musefa Redwan, Eyasu Muse, Girma Nina, Bizuneh Sime, Addisalem Tadege, Anbesse Jima, Nugusu Ayalew, Dagmawi Workneh, Daniel Teferi, Momodou T Nyassi, Landing N Sanyang, Omar Jallow, Abdoulie Keita, Kitabu Jammeh, Charles Roberts, Patrick Idoko, Kebba Marenah, Masirending Njie, Musa Marena, Karamba Suwareh, Simon Boissey, Fatoumatta Jarjusey, Awa Jah, Awa Sanyang, Dado Jabbi, Kajali Camara, Armando Correa, John Jabang, Lamin Jaiteh, Lamin Dampha, Aminata Manneh, Baboucarr Sowe, Abdoulie Bah, Edrisa Jawo, Victoria Okoje, Momodou Baro, Yaya Bah, Mustapha Njie, Sainabou Mbowe, Ebrima Kanteh, Sarjo Ceesay, Alagie Manneh, Evans Atito-Narh, Adwoa Wilson, Romeo Hussey, Emmanuel Okine, Jemima Kwarteng, Ridge Ntiamoah, Samuel Dadzie, Mark Aseti, Naa Sowah, Akosua Appiah, Charles Bankah, Patrick Mburugu, Thomas Chokwe, Patrick Olang, Vernon Gacii, Susane Nabulindo, Antony Gatheru, Timothy Mwiti, Caroline Mwangi, Julius Muriithi, Daniel Ojuka, Omondi Ogutu, Evans Masitara, Mohamed Chaudhry, Reuben Kamundi, Annmarie Kangangi, Thomas Massaquoi, Stephen Takow, Felister Moraa, Aziz Munubi, Moses Kimani, Adili Wobenjo, Linda Nguu, Vincent Omeddo, Rose Malaba, Ambrose Nabwana, Anita Mwancha, Alexandria Mugaa, John Wamwaki, Joyce Chege, Seymour Sinari, Andrew Ndonga, Rose Shitsinzi, Walter Akello, Winfred Kimani, Elisha Kirwa, Seno Saruni, Andrew Wainaina, Ernest Nshom, Aidah Kenseko, Kizito Shisanya, Purity Wanjiru, Julliah Cherotich, Judy Kimutai, Benson Wahome, Grace Wangui, Dennis Wamalwa, Stephen Mwangi, John Chege, Tabitha Wanjiku, Carolyne Njoki, Wachira Waititu, Conrad Ambani, Samuel Murimi, Sharon Waithira, Nilson Mouti, Collins Kibet, John Kibet, Virginia Sokobe, Beatrice Jeymah, Antony Kamadi, Faith Gichuri, Steve Moses, David Wasike, Favours Adeya, Caesar Bitta, Stephen Ogendo, Killian Kariuki, Hdaya BenAbdalla, Taha Suliaman, Fatima Ali Abokhzam, Mohaned Isa, Mohammed Huwaysh, Asma Bourawi, Kais Alzubaidy, Mohammed Albaraesi, Sumayyah Bahroun, Abdulmueti Alhadi, Ahmed Msherghi, Amira Mohamed, Ala Khaled, Nouran Aljadi, Elham Bareig, Khaled Elgazwi, Adel Elgazwi, Ibrahim El-busife, Safa Owhida, Almahdi Eltwati, Samah Elakeili, Taha Abubaker, Fatima Elkhfeefi, Soha Younis Hasan, Amal Alttaira, Imbarkah Elmraied, Rim Wishah, Omar Abugassa, Hazem Ahmed, Amera Ellafi, Shoukrie Shoukrie, Nawal Aldokali, Aws ElGammudi, Akram Alkaseek, Hoda Elhaddad, Ayyah Alqaarh, Ahlam Brish, Malek Abudsnnuga, Salsabil Albuaishi, Mohammed Albashri, Marwa Morgom, Mohammed Alawami, Eman Shawesh, Abdullah Almabrouk, Moaz Alwarfalli, Nagia Abeid, Anis Buzreg, Ans Malek, Ameerah Abayu, Butaina Abdulhafith, Wedad Abouruwes, Marim Albakuri, Sabria Almuammari, Esam Alsaghair, Fatheia Alreshi, Hassan Badi, Rabiee Alfetoey, Naji Zubia, Bushray Almiqlash, Abdulsalam Alshuhoumi, Rayet Al-islam Ben Jouira, Amaal Dier, Essra Gebril, Mohammed Abdelkabir, Sana Moussa, Marwa Alfitori, Mabroukah Azbeda, Hajar Alamin, Ejmeya Barka, Omlsaad Mosbah, Rema Abdasalam, Miftah Hiyoum, Maryam Abd allateef, Ibrahim Altomi, Mahdi Alsakloul, 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Christopher Ukah, Abolade Olugbenga, Nwachukwu Chidiebere, Nasiru Abdulraman, Adebiyi Olusegun, Alisa Halisa, Semiat Yusuf, Jamila Salisu, Chidiebube Okoro, Abdul Suleiman, Fabian Onowighose, Aliyu Farinyaro, Suleiman Baba, Umar Abdulmajid, Aisha Abdurrahman, Ogochukwu Obi, Olatunde Alabi, William Adeyemi, Jelili Salau, Jones Taiwo, Nnaemeka Nwafulume, Taiye Ibiyeye, Edith Agu, Ayodeji Danboy, James Abdulazeez, Christopher Ekwunife, Chimaobi Nnaji, Chigozirim Onyekpere, Amara Arunsi, Jude Egwim, Obianuju Nwana, Nnabuike Ojiegbe, Charles Mbamba, Paul Ngwu, Frank Imahigbe, Emmanuel Okoroji, Iloh Ikenna, Abdulrahman Mohammed, Adebayo Adeniyi, Toluwalope Ariyo, Olajide Gabriel, Tesleem Orewole, Salawu Idris, Idowu Adebara, Abiodun Okunlola, Akinwale Akinbade, Oluwasesan Afolabi, Adewumi Bakare, Olabisi Adeyemo, Benjamin Ugwu, Samuel Nuhu, Henry Embu, Erdoo Isamade, Chinedu Obikili, Amaka Ocheke, Solomon Peter, Donald Orshio, Peter Onuminya, Jack Okopi, Olufemi Bankole, Bosede Afolabi, Dapo 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Omoshoro-Jones, Motselisi Mbeki, Estie Cloete, Philip Anderson, Busi Mrara, Annemarie Steyn, Tsakani Mhlari, Nic Proctor, Caroline Robertson, Gillian Lamacroft, Usha Singh, Sebenzile Sikhakhane, Kelly Gate, Shepherd Nzenza, John Tshimbalanga Kasonga, Sibongile Ndebele, Patrick Lufuta Kande, Jody Davids, Tino-vito Orlandi, Marischka de Jong, Hugo Stark, Francois Roodt, Jonathan Hall, Ian Nortje, Akanimo Akpakan, Vishendran Govindasamy, Ronisha Sathiram, Mohammad Kathrada, Zane Farina, Lucio Frittella, Charles Kohler, Sibuyiselwe Lubelwana, Sarwat Ikram-Hameed, Adriaan Smit, Muneerah Cassiem, Yvonne Freeman, Saaliha Goga, Larissa Cronje, Constantin Buzdugan, Subash Chirkut, Priyadeshni Singh, Sandhya Jithoo, Vivesh Rughubar, John Arnold, Rishan Bipath, Suman Mewa Kinoo, Ncumisa Khanyisa Msolo, Fleur Ackermans-Deijnen, Tshegofatso Mmasello Emma Boka, Martyn Biccard Greenwood, Shakthi Anand Jayrajh, Devarani Naidoo, Syndrini Reddy, Devandiran Harriraman Rungan, Kylene Subrayen, John Roos, Nina Tredoux, Pascal Plumacher, Anthony Reed, Harald Steinhaus, Mariesa Nock, Paul Ryan Herselman, Gareth Davies, Talitha Harvey, Franklin Muller, Willem Naude, Tania Pretorius, Johan Jochemus Swart, Merryn Walls, Prashant Gokal, Nicolette Rorke, Farzaana Dhoodhat, Precious Dzanibe, Mohammed Yusuf Hussain, Ashmita Junpath, Ameela Maharaj, Hylda Makanisi, Khalid Moosa, Ting Ting Wong, Sean Mould, Trisha Ramsamy, Roel Matos-Puig, Hayley Morgan, Nadeem Nabeebuccas, Ria Devi Naidoo, Viantha Pather, Vasheel Vasheel Bahadur, Renilda Pillay, Zahnne Fullerton, Nicole Bell, Bongisa Grey, Vincent Lorenzo Visentin, Hendrik Adriaan Van Zyl, Terri Anne Killingbeck, Emile Maneveldt, Gerhard Thiart, Magdelena May Venter, Oostewalt Swart, Mariette Grobelaar, Carel Cairns, David Bishop, Christien Steenkamp, Thandekile Khumalo, Noel Naidoo, Ross Murray, Martin Kopieniak, Melusi Sishange, Mxolisi Brian Ndimande, Megan Jaworska, Sarwat Ikram, Bence Rainier, Renier J Liebenberg, Helena D Zwiegers, Philip M Nortje, Kamal Bhagwan, Margot Flint, Robert Dyer, Simone Adams, Yoshua Bwambale, Danny Ngomo, Patrice Kanku, Nivashen Pillay, Alexa de Castro, Atisha Maharaj, Janine Carim, Jenna Leigh Taylor, Karl M Köhne, Leanne W Drummond, Leanne Temlett, Lieze Geldenhuys, Yvonne Seilbea, Kathryn Naidoo, Nicola A Kalafatis, Stefné Verwey, Thulile Biyase, Theroshnie Kisten, Belinda S Kusel, Timothy Craig Hardcastle, Richard Magagula, Christian Kampik, Kuzolunga Xulu, Sivuyisiwe Solala, Mia Sayed, Basil Enicker, Anil Madaree, Innocent Mukama, Gladmore Madombwe, Nonhlanhla Zulu, Nompumelelo Gasa, Nokuzula Kanjana, Sebenzile Buthelezi, Thembelihle Buthelezi, Andries Brink, Francois Potgieter, Busisiwe Mrara, Zaynab Alexander, Charles Choto, Paula Ima, Zintle Gxagxisa, Baphethuxolo Ningiza, Gillian Lamacraft, Jerome Mogorosi, Nadia du Plessis, Leonie de Man, Suné Thompson, Gerrit van Heerden, Edwin W Turton, Pieter M van der Linde, Josephine K Teme-Pitse, Reitumetse Tladi, Gillian D Saffy, Ene-Mari Roscher, Kristel Fortune, George Barnard, Tiisetso Makhasane, Evan Bowen, Akangcha Pal, Rachel Moore, Maria Fourtounas, Mary Augusta Adam, Renessa Arumugan, Gabriella Hyman, Jaclyn Jonosky, Maninginingi Makondo, Heveshan Moodley, Phillip Munda, Mzwandile Nyalungu, Victor Olusola, Sohan Zane Pinto, Tristan Pillay, Lucinda Singh, Paul Mwindekuma Wondoh, John Devar, Boitumelo Baloyi-Mnisi, Zach Koto, Matlou Ernest Mabitsela, Sibongile Ruth Ndlovu, Branny Mthelebofu, Colin Beck, Matthew Dold, Alice Fan, Shannon MacQueen, Thembani Matabata, Catherine Mpehle, Charné Kulenkampf, Tsakani McCreath Mhlari, Simangele Cecilia Nyoka-Mokgalong, Felix Thumba Masinge, Randhir Ramnath Gunpath, Maropeng Petrus Pat Mothwa, Jo-Anne Asenath Mothwa, Danai Mhlanga, Jamie-Lyn Colly, Aunel Mallier Peter, Khalid Ben Hameda, Pulane Mokae, Stella Josephine Moumakoe, Kelechi Ekeh, Nezingu Lengo, Marnus Booyens, Inge Louise Seale, Pieter Daniel Theron, Nicolaas Abraham Schuman, Amber Carlyn Sonn, Jacobus Lukas Stander, Nadia Cloete, Marius Cloete, Catherine Ann Makepeace, Ronel van der Westhuizen, Leanne Robyn Messiahs, Amy Ruth Visagie, Fatima Vawda, Frans Christiaan Voster, Deepika Dhilraj, Oliver Smith, Stefan Bolon, Daniel Montwedi, Motsilisi Mbeki, Jayde Wyngaard, Mthunzi Ngcelwane, Thomas Kleyenstuber, Phyllis Phukubye, Liesel Schärf, Grace Laker, Elizabeth Semenya, Reinhard Dembskey, Thomas Tarlton, Tapiwa Jiri, Ngoie Hubert Mushid, Nhlanhla Samuel Ngwenya, Hazel Morongoa Mogodi, Carmen Sinevici, Anthony Osarogie Usenbo, Naledi Fodo, Anesu Chimini, Ntetelelo Sikobi, Sinovuyo Nokwange, Mluleki Noqhamza, Qumba Thembisa, Kajake Anantha Padmanabha Bhat, Rabin Mathew, Katrin Middleton, Abdus-sami Adewunmi, Craig Dickson, Humairah Bulbulia, Bianka Bester, Michelle de Klerk, Christia Benade, Francois Viljoen, Monique Fischer, Khalid Alfaki, Abdalmalik Awad, Abdelsalam Algray, Mohammed Elsiddig, Suha Mohamed, Salih Mahmoud, Muhammed Osman, Asia Elgailany, Mazin Suliman, Hanaa Mohammed, Lina Aljeally, Mohammed Dirar, Mohammed Osman, Mazin Mohamed, Mohamed Elhasan, Abrar Widatalla, Abubakr Abubakr, Eman Mohamed, Alshareef Nour, Ntonto Doris Gama, Dolorosa Khetsiwe Shabangu, Cynthia Iradikunda, Samuel Mkoko, Paul Kisanga, Emmanuel Lema, Benson Lyimo, Mohamed Binde, Alphonce Chandika, Salim Salim, Sylvia Jumbe, Abel Makubi, Vihar Kotecha, Felician Kachinde, Museleta Nyakiroto, Emmanuel Jitambi, Venant Geofrey, Johaphes Josiah, Phinius Makubi, Frank Manumbu, Suzan Mlingwa, Ernest Ibenzi, Peter Mbelle, Kato Peleus, Enid Chiwanga, Nillah Richard, Shoo Leonard, Paulo Sanka, Subira Mushi, Bashir Nyangasa, Mohamed Janabi, Naizihijwa Majani, Pedro Palangyo, Evarist Nyawawa, William Ramadhan, Faraj Lydenge, Gileard Gabriel Masenga, Sakina Rashid, Mubashir Jusabani, Ansbert Ndebea, Jenitha Cheru, Margaret Henjewele, Greyson Kilimanjaro, Sarah Sikimata, Deocles Donatus, Hazina Maduhu, Tumaini Mariro, Given Massasi, Moshi Moshi Shabani, Braison Cholela, Marco Mgeleka, Yohatinus Mbilinyi, Faraja Chiwanga, Bilton Exavery, Caspar Haule, Samson Ndile, Sirili Harya, Julieth Magandi, Deogratius Manyama, Redempta Matindi, Adam Moshi, Daudi Kitwana, Merida Makia, Philip Muhochi, Miriam Herman, Clauda Miombo, Furaha Kahindo, Langtone Kishebuka, Elijah Ussiri, Gloria Kinasa, Patrick Adel, Eric Malaba, Vensesla Sakwari, Sadot Lugereka, Mohamed Mungia, George Mocha, Herman Wella, Cecilia Protas, Patrick Karua, Ahmada Kashagama, Faraja Mwasambugu, Suzana Kajeri, Jacquiline Mchilla, Elibariki Lucumay, Robert Maise, Amon Marti, Beatrice Mahundi, Frederika Jager, Charles Majani, Ludovick Rukeha, Tareeq Mohamed, Nabila Fuad, Winifrida Halinga, Elias Chrisant, Gilbert Msoma, Titus Kihwili, Gadiel Temu, Naima Yusuf, Rashid Saleh, Rashid Inoja, Eva Shang'a, Stella Ibrahim, Hussein Msuma, Edwin Edward, Paul Kilamile, Stephen Mwakyolile, Talkana Adja, Edem Gueouguede, Hafoudhoi Oussene Seddoh, Saliou Adam, Pilakimwe Egbohou, Mawunyo Ahomagnon, Olivier Kadjossou, Abdul-Bassiti Boukari, Mary T Nabukenya, Ruth Muhindo, Peter Waswa, Peter Kaahwa Agaba, Daphne Kabatoro, Joseph Kayong, Margaret Naggujja, Nabasiige Rehema, Phiona Nansubuga, Daniel Kavuma, Aggrey Lubikire, Hope Bisilikirwa, Godfrey Ssebaggala, Emmanuel Muwema, Humble Joan Agaba, John Kiconco, Nicholas Wataaka, Bonet Chan, Mary Juliet Nampawu, Fred Bulamba, Emmanuel Bua, Christine Mugala, Caroline Nyakato, John Paul Ochieng, Linda Kyomuhendo Jovia, George Kateregga, Rachel Alum, Lazia Najjuma, Gorret Nampiina, Andrew Kintu, Joshua Sempiira, Luzige Simon, Peter Kayima, Jacob Eyul, Erick Odwar, Rita Nkwine, Christine Namata, Elizabeth Nabakka, Denis Kakaire, Velda Mushangwe-Mtisi, Erisha Munhamo, Celestino Dhege, Juliet Hungwa, Hemish Jasi, Crispin Ntoto, Derek Matsika, Brightson Mutseyekwa, Joseph Zimbovoora, Beaulah Gudyanga, Dennis Mazingi, Chenesa Mbanje, Busisiwe Mlambo, Michael Chiwanga, Harunavamwe N Chifamba, Sarudzai Zhou, Esta Hove, Shamiso Dende, Beauty Manjengwa, Penias Kapisa, null Mashava, Caritas Chiura, Locadia Katsukunya, Godfrey Muguti, Doreen Mashava, Elton Ndhlovu, Zanele Mangwangwa, and Nombulelo Dube

Subjects
Adult, medicine.medical_specialty, Standard of care, business.industry, Psychological intervention, MEDLINE, Standard of Care, General Medicine, Articles, Hospitals, Hospitalization, Intervention (counseling), Relative risk, Emergency medicine, Africa, medicine, Humans, In patient, Female, Cluster randomised controlled trial, Postoperative Period, business, Surgical patients
Abstract

Summary Background Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality. Methods We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov , NCT03853824 . Findings Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported. Interpretation This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa. Funding Bill & Melinda Gates Foundation and the World Federation of Societies of Anaesthesiologists. Translations For the Arabic, French and Portuguese translations of the abstract see Supplementary Materials section.

Published
2021

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