[Epidemiological characteristics and prognosis of gastric Cancer in urban areas of Mali]

Stomach cancer remains a public health problem. It is increasingly found in our regions, probably because of the greater availability and improvement of diagnostic facilities. The goal of this work was to study the epidemiological characteristics and prognosis of gastric cancer in the hepato-gastroenterology and general surgery wards of the Gabriel Toure university hospital.

METHODS

We conduct a descriptive retrospective study on patients from June 2008 to May 2009, and the enrollment of patients lasted from June 2009 to May 2010.

RESULTS

We examined the records of 68 cases of gastric cancer in 115 cases of digestive cancers a frequency of 59.1%.

The mean age of patients was 56.51 ± 14.8 years with extremes of 27 and 90 years. The sex ratio was 1.6 in favor for men. The social and professional groups (housewives and farmers) were the most represented with 50 cases (73.5%). Salting, smoking, consumption of tô (cereal dough) with potash were the most found risk factors in 80.9%, 94.2% and 80.6% of cases respectively. The localization of antro-pyloric site was most represented (60.3%). Adenocarcinoma was the most common histological type (94.1%), one case of Gastrointestinal Stromal Tumor (GIST), two cases of non hodgkin malignant lymphoma were found.The curative surgery was performed in 8.9% of our patients. The overall survival rate after any surgery with two-year follow-up was 9.4%. Post curative surgery survival was 83.3% at two years follow-up.

CONCLUSION

Stomach cancer is common in our context, but its management is suffering from delayed diagnosis.

[Epidemiology of anguillulosis among public school children in Abidjan, Cote d'Ivoire]

PURPOSE

Strongyloides stercoralis is a neglected soil-transmitted helminth species. In Cote d'Ivoire, as elsewhere, there is a lack of parasitologic and epidemiologic data pertaining to this parasite. The purpose of this study was to evaluate the prevalence and impact of sociodemographic factors on anguillulosis among public school children in Abidjan, Cote d'Ivoire.

METHODS

Testing for Strongyloides stercoralis was performed in a random sample of 411 children from 10 public primary schools in Abidjan. Detection methods included direct examination of stool smears, the Baermann test and helminth coproculture study.

RESULTS

The overall prevalence of anguillulosis was 2.7% (N=411) (IC95% = 1.34-4.73). The M/F sex-ratio was 1. No correlation was found between prevalence and sex (p = 0.12). Prevalence was higher among children who reported contact with swamps and rivers (respectively 80% and 7.9%) than those who did not report such contact (respectively 1.7% and 1.5%) (p <0.01).

CONCLUSION

Contact with swamps and rivers is correlated with an increase in anguillulosis prevalence. Avoiding these areas and proper sanitation could help to reduce the prevalence of anguillulosis in Abidjan.

[Changing aspects of cirrhotic disease in a hepato-gastroenterology service in Mali]

The main goal of our study was to evaluate cirrhosis course on one year. The study was prospective and longitudinal from January 2005 to December 2006 in the center of hepatology and gastro-enterology of CHU Gabriel Touré. The patients had one year follow up and examinated every three months. In this study 57 patients were included. Mean age was 41,5 + 15,3 years. Ascite and jaundice were the main clinical signs respectively 70.2% and 54.4%. Ascite or its increase was the most complication in 67.5% of cases (p = 0.002). The global mortality was 82.5% and it was high in the three first months, caused by hepatocellular carcinoma, digestive bleeding and hepatic encephalopathy respectively 33.3%, 27.3% and 15.2%. Abdomen pain, ascite and jaundice have an predictive value for high mortality (p between 3.10-3 et 10-7). Early examination, therapeutic observance and good management of cirrhosis complications could reduce the mortality.

[Undesirable effects of medicine in the Internal Medicine Service of the University Hospital Center du Point G]

The aim of this study was to determine the frequency of adverse reactions to drugs, the WHO grade, describe the clinical features and identify the drug responsible. This was a descriptive cross-sectional study which took place from February 2005 to January 2006 in the Internal Medicine Department at the hospital point G. Were included in this study, all patients hospitalized during the study period, which presented adverse drug reactions (ADRs) that the relation of cause and effect was certain or likely. Thus, 47 ADRs were identified in 39 patients of 426 admitted during the same period a frequency of 9.2%. The average age of our patients was 48.5 ± 16.5 years. The sex-ratio was 1.6 for women. Eighty-two percent of our patients had an ADR and 18% more than one. The WHO grade 1 was the most met or 36.2%, followed by grades 4 and 2 respectively 27.7% and 25.5%. Antidiabetics were responsible for adverse reactions in 46.8% and 21.3% in TB. Adverse events were neurological in 53.2% and type of manifestations of hypoglycemia 46.8% (22/47 cases), polyneuritis 6.4% (3 / 47 cases) and 29.8% in digestive cases dominated by vomiting 12.8% (6 / 47 cases), the epigastria pain 6.4% (3 / 47 cases). The outcome was favorable in 87.2% of cases, however, 3 cases of death among those over 60 years all grade 4 WHO. ADRs deserve special attention to this high death rate (6.4% 3/47 cases) where the interest to search systematically for all patients under medical treatment with a good clinical examination and questioning some thoroughly.

[Neuromeningeal cryptococcosis in non-HIV patients to CHU ward of Point G in Bamako (Mali): 3 case report]

We report 3 clinical observations of neuromeningeal cryptococcosis which occurred without any immunodepression related to HIV infection. Our patients were male. They did not present any particular medical history indicating a diagnosis of cryptococcosis. Nevertheless we found a professional exposure to the risk of inhalation of C. neoformans capsules. The diagnosis was based on presence of encapsulated yeast of Cryptococcus in the direct exam by China ink and culture on Sabouraud medium. CD4 lymphocytic count was done in two patients (case 1:899 cells/mm3; case 2:347 cells/mm3). Idiopathic lymphocytopenia was noted in one case. Co-morbidity of 5. pneumoniae meningitis was reported in one patient (case 3). Treatment was based on injectable amphotericin B in monotherapy (case 1), followed by perfusion of fluconazole cure (case 2). Case 3 was treated by perfusion of amphotericin B associated with ceftriaxone (case 2). No secondary prophylactic treatment was administered. Evolution was favorable after follow-up of 5 years (case 1) and of 4 years (case 2). The third patient died during hospitalization.

Interferon regulatory factor-1 polymorphisms are associated with the control of Plasmodium falciparum infection

We describe the haplotypic structure of the interferon regulatory factor-1 (IRF-1) locus in two West African ethnic groups, Fulani and Mossi, that differ in their susceptibility and immune response to Plasmodium falciparum malaria. Both populations showed significant associations between IRF-1 polymorphisms and carriage of P. falciparum infection, with different patterns of association that may reflect their different haplotypic architecture. Genetic variation at this locus does not therefore account for the Fulani-specific resistance to malaria while it could contribute to parasite clearance's ability in populations living in endemic areas. We then conducted a case-control study of three haplotype-tagging single nucleotide polymorphisms (htSNPs) in 370 hospitalised malaria patients (160 severe and 210 uncomplicated) and 410 healthy population controls, all from the Mossi ethnic group. All three htSNPs showed correlation with blood infection levels in malaria patients, and the rs10065633 polymorphism was associated with severe disease (P=0.02). These findings provide the first evidence of the involvement in malaria susceptibility of a specific locus within the 5q31 region, previously shown to be linked with P. falciparum infection levels.

[Digestive parasitic diseases to HIV/AIDS infected patients of internal medicine and infectious diseases wards of the hôpital du Point "G" Bamako - Mali]

We conducted a prospective study in internal medicine and infectious diseases wards of the hospital of Point " G " in Bamako, Mali from January to December 2002. Overall 112 patients HIV positive, thirty-five patients (31,25%) had at least a digestive parasitic disease. We found that the most frequent parasite in stools sample were protozoa (82,85%). The second most frequent parasites were helminthes (20,33%). HIV/AIDS opportunistic parasites represented 40% of all parasites found. These included 25,71% cases of Cryptosporidium sp, 8,57% cases of Isospora belli and 5,71 % for microsporidia. The functional signs of our patients were mostly asthenia and weight loss. The physical signs were conjunctive pallor (71, 42%) and diarrhea (85, 71%). Generalized itching was present in 54, 28% of cases and abdominal pains in 25, 71% of cases. The global lethality was 37, 14% (13/35). The deaths were due to the HIV infection. The parasites appear even frequent at patients infected by HIV/AIDS, in spite of the advent of antiretroviral therapy. The efficient molecule research against the opportunist parasite must constitute one of our priorities in tropical area.

Genetic complexity and gametocyte production of Plasmodium falciparum in Fulani and Mossi communities in Burkina Faso

We have examined Plasmodium falciparum gametocyte prevalence, density and their genetic complexity among children of 2 sympatric ethnic groups (Mossi and Fulani) in villages in Burkina Faso. The 2 groups are known to have distinct differences in their susceptibility and immune responses to malaria. We used RT-PCR and sequence-specific probes to detect and type RNA of the gametocyte-specific protein Pfs48/45. There were no differences in detection rates of asexual forms and gametocytes among the 2 groups, using PCR and RT-PCR, respectively. However, there were significant differences in densities of asexual forms and gametocytes, which were both higher among Mossi than Fulani. Both asexual forms and gametocyte densities were influenced by age and ethnicity. Multiple-clone infections with more than 1 gametocyte genotype were equally prevalent among Fulani and Mossi. These differences can most probably be attributed to genetic differences in malaria susceptibility in the 2 ethnic groups.

Incidence et présentation des manifestations neurologiques centrales au cours de la granulomatose de Wegener : analyse monocentrique d’une série de 14 malades

PURPOSE

Central nervous system manifestations are rare clinical features of Wegener's granulomatosis, and occur in 4-8% of the patients, but few studies were dedicated to them.

METHODS

This retrospective study (1988-2001) include 14 consecutive patients suffering from Wegener's granulomatosis. Involvement of central nervous system was defined as follows: suggestive neurological signs, compatible cerebral imaging, efficacy of the specific treatment of the granulomatosis.

RESULTS

Four patients had a central nervous system manifestation (29%), including three women (average age 51 years). The signs were inaugural in a case. The manifestations were the following: sensibility disturbance (three cases), motor weakness (two cases), aphasia (one case), and mood disorders (two cases). Cranial nerves were constantly involved. Cerebral magnetic resonance imaging findings were: pachymeningitis and venous thrombosis (one case), vasculitis (two cases). Under steroid therapy associated with cyclophosphamide, in spite of a recurrence at 27 months in one patient, all patients had a complete remission. There was no death, with a median follow-up of 66 months. Except the ocular signs, that were more common (three cases), these patients had the usual characteristics of the Wegener's granulomatosis: rhinosinusitis (four cases), pulmonary (three cases), renal (three cases), and peripheral nervous system involvement (three cases).

CONCLUSIONS

Our study, based on precise criteria, indicates that the frequency of the central neurologic manifestations of Wegener's granulomatosis is probably under estimated. Cranial nerves involvement is highly evocative. The long-term prognosis seems good, in spite of the associated multivisceral disorder.