[Gunshot wounds of low urinary tract in period of security crisis at the Sominé Dolo Hospital of Mopti (Mali): Epidemiological and diagnostic aspects]

INTRODUCTION

Firearm injuries to the lower urinary tract are injuries resulting from an energy transfer from a projectile fired by a firearm or a blast from a firearm, to the bladder, prostate, urethra and terminal ureter. Our objective was to describe the epidemiological and diagnostic aspects in the context of a security crisis.

PATIENTS AND METHOD

This was a descriptive cross-sectional study of lower urinary tract firearm injuries at Sominé Dolo Hospital in Mopti from January 2017 to December 2021.

RESULTS

In five years, 29 traumas of the lower urinary tract have been collected, about 6 cases per year. The mean age of patients was 27.48 years, the sex ratio was 13.5/1. The main circumstances of occurrence were intercommunal violence 51.72 %, war wounds 31.03 %. Injuries were inflicted by rifles in 62.1 % and improvised explosive devices in 37.9 %. The main modes of discovery were acute urine retention, hematuria and penoscrotal wounds respectively in 31.03 %, 20.69 %, 17.24 %. The organs affected were the urethra in 58.62 %, the bladder, 37.93 %, the prostate 3.45 %. Associated non-urological lesions present in 68.96 % (n=20) were dominated by intestinal lesions and pelvic fractures.

CONCLUSION

Firearm injuries to the lower urinary tract are rare despite the context of the security crisis. They affect young men, are mostly linked to intercommunal violence, and are dominated by urethral and bladder injuries.

[Susceptibility Of ABOS Blood Groups To COVID-19 At The National Institute Of Public Health (INSP) Of Mali In 2020]

INTRODUCTION

Several authors have suggested an association between the ABO system (ABOS) and the risk of SARS CoV-2 infection. The objective of the present study was to identify the susceptibility of ABOS blood groups to COVID-19 at the National Institute of Public Health (INSP) of Mali.

MATERIAL AND METHODS

This was an unpaired case-control study. The cases (402) were COVID-19 patients, and the controls (5438) were Muslim pilgrims, all of whom had undergone ABO blood grouping at the INSP. Logistic regression was performed to identify factors associated with SARS-CoV-2 infection status using SPSS version25 software.

RESULTS

Blood types had the following frequencies: O(34%), B(30%), A(28%), AB(8%) for cases and O(42%), B(27%), A(25%), AB(6%) for controls. COVID-19 positive status was not significantly associated with blood groups A(oR=1.17; CI95%[0.93-1.47]), B(OR=1.11; CI95%[0.89-1.39]) and AB(OR=1.41; CI95%[0.97-2.06]). However, blood group O subjects were 28 times less likely to have COVID-19 than non-O(OR=0.72; CI95%[0.58-0.89).

CONCLUSION

The results show that blood group O individuals were less likely to have SARS CoV-2 infection than non-O individuals. This should not affect the use of barrier measures in ABOS groups.

[Central corneal thickness in black children examined under general anesthesia at the Yalgado Ouédraogo University Medical Center]

INTRODUCTION

Central corneal thickness measurement permits an evaluation of physiological and pathological corneal changes. It allows for an intra-ocular pressure correction factor. Our purpose was to determine the mean central corneal thickness in children aged 0 to 72 months and to examine factors that might affect it.

PATIENTS AND METHODS

This was a cross-sectional hospital study which took place from February to December 2019 in the ophthalmology service of YO University Medical Center. It included healthy eyes of children 0-72 months of age examined under general anesthesia. Ultrasonic pachymetry was used to measure the central corneal thickness. The studied variables were age, sex, CCT, corneal diameter, intraocular pressure, and cup/disc ratio.

RESULTS

One hundred and twenty-seven healthy eyes of 78 children 0-72 months of age were included. The mean age was 22 months. The overall mean CCT was 554.01±34.21μm. It was 556.58μm for children from 0 to 36 months of age and 536.12μm for subjects over 36 months. The mean CCT was 555.96±32.96μm in boys and 551.80±36.16μm in girls. In patients who underwent bilateral CCT measurement, the mean CCT was 554.74±35.67μm in the right eye and 549.76±24.08μm in the left eye. Lower IOP's were found in patients with thicker corneas (p=0.00).

CONCLUSION

The CCT values for black children over 36 months of age was similar to the CCT in black adults.

[Overview of visual impairment at the Yalgado Ouédraogo University Medical Center: Study of 501 cases]

OBJECTIVE

To determine the main causes of visual impairment according to age in patients admitted to the ophthalmology department.

MATERIALS AND METHODS

This was a retrospective study of 501 cases of visual impairment. Included were patients of both sexes whose best-corrected visual acuity in the better eye was strictly less than 5/10. The parameters studied were age, gender, place of residence, corrected visual acuity in the better eye, and diagnosis. The data were entered and processed with the Epi info 7.2 software.

RESULTS

Subjects over 50 were the most prevalent (48.5%). In patients over 50 years of age, cataracts (54.32%) were the leading cause of visual impairment, followed by glaucoma (24.69%) and non-glaucomatous optic neuropathy (26.19%). Trauma (17.62%) was frequently found in patients aged 16 to 50 years. Tropical endemic limbo-conjunctivitis (25.00%) was the leading cause of visual impairment in subjects aged 5 to 15 years.

CONCLUSION

This study confirms the results of the literature, which have shown that cataracts are the leading cause of visual impairment in developing countries. A major effort to raise awareness, provide information and therapeutic care would reduce the incidence of visual impairment.

Epidemiology and spatio-temporal distribution of gastrointestinal parasites infection and accuracy of FAMACHA test in sheep in traditional farming systems in Burkina Faso

Blood and faecal samples from 2086 Sahelian and Djallonke sheep have been collected to assess the epidemiology and spatio-temporal distribution of gastrointestinal parasites. A survey with a questionnaire allowed collecting data on individual animal and farms. Faecal samples were analysed using the McMaster technique, while anaemia was assessed using FAMACHA score test and packed cell volume. The overall prevalence of gastrointestinal parasites was 91%, and strongyles (70.7%), Eimeria sp. (60.4%), Moniezia sp. (5.7%), Stronyloides sp. (0.9%) were identified. There was no significant association between the region and strongyles infection (P ˃ 0.05). Animals sampled during the rainy season (n = 565; P = 82.2%, mean EPG = 154.8 ± 12.02) were mostly and heavily infected than those from the hot dry (n = 518; P = 74.2%; mean EPG = 97.7 ± 17.4) and the cold dry season (n = 392; P = 55.5%; mean EPG = 24.5 ± 19.5) (P ˂ 0.05). Females (n = 1027; P = 72.1%; mean EPG = 77.6 ± 17) were most infected than males (n = 448; P = 67.7%; mean EPG = 61.6 ± 19.5) (P ˂ 0.05). Animals that were treated, at most 3 months before sampling (n = 166; P = 61.5%; mean EPG = 41.7 ± 21.4), were less infected than those, which received this treatment after three months before sampling (n = 199; P = 74.8%; mean EPG = 89.1 ± 15.8) (P ˂ 0.05). Data from blood samples indicate that 6.5% of sheep was anaemic (PCV ≤ 19%), while 59.7% was noted anaemic regarding FAMACHA scores. PCV values varied significantly for FAMACHA scores, and the highest mean value was noted for score 1 (27.6) (P ˂ 0.05). The Cohen's kappa score between FAMACHA and PCV was 0.02. These findings suggest that strongyles infections are significantly associated with season, and heavier infections were noted during rainy season.

From farmers to livestock keepers: a typology of cattle production systems in south-western Burkina Faso

Cattle production is an essential livelihood strategy in south-western Burkina Faso. Although having a distinct cultural role and known to be resistant against African animal trypanosomosis, the Lobi taurine cattle breed is endangered due to its low market value. As the first step in preservation efforts, our study aimed to develop a typology of production systems at the farm level. We used a structured questionnaire and focus group discussions for collecting data on household characteristics, socioeconomic activities, livestock, and access to services. The sample comprised 169 households in three communities. The analytical strategy included factor analysis of mixed data and hierarchical clustering. We identified four distinct types of cattle production systems: (1) sedentary Lobi farms, (2) sedentary crossbreed farms, (3) semi-transhumant Fulani zebu farms, and (4) transhumant Fulani zebu farms. Significant factors in developing this typology were the farmers’ ethnic group, crop diversity, cattle herd size, cattle herd composition, number of small ruminants, and livestock management strategies. Across all production systems, men were considered being primary decision-makers in cattle production, with women, herders, and children being responsible for specific tasks. All identified production systems are increasingly confronting disease pressure and scarcity of water and land. Future efforts in preservation and breeding will need to respond to these trends in the agroecosystem, integrate risk management measures, and resonate with the specific needs of the different household members involved in cattle rearing.

[Health care-associated infections in teaching hospital Gabriel TOURE]

OBJECTIVES

To study health care-associated infections (HCAI) in teaching hospital Gabriel TOURE.

METHODOLOGY

This was a prospective study of 6 months (from April to September 2016) which included patients admitted to the General Surgery Department, operated or not, except those who had undergone a necrosectomy. The criteria used for the diagnosis of the infection were those of the CDC of Atlanta.

RESULTS

A total of 200 patients were included in the study. Twenty one patients developed IAS that is a frequency of 10.5%. There were 11 men and 10 women with a mean age of 37.7 years with a standard deviation of 17.6 years. Surgical site infection was the most common HCAI (77.3%) followed by urinary tract infection (13.6%) and burn infection (9.1%). The influencing factors were those related to the patients (nutritional status p = 0.004, anemia RR = 3.1 IC p = 0.003 and diabetes), those related to the surgical intervention (the duration of the intervention ≥ 2H, p = 0,0001, the Altemeier class 3 and 4, RR = 4.24, IC p = 0.005, the number of interveners in the blocks ≥7, p = 0.000, the NNISS score 1 and 2 p = 0.0009), invasive procedures (bladder catheter ≥ 4 days p = 0.0000). Escherichia coli was the most isolated microorganism (31.2%) followed by Klebsiella pneumonia and A baumannii (18.7%). The treatment was local (twice-daily dressing with antiseptics), surgical (necrosectomy 16% and re-intervention 10%) and general (adapted to the antibiogram). The consequences of HCAI were an extension of total hospital stay (greater than 7 days) with p = 0.0000, morbidity 3% and mortality 5%.

CONCLUSION

HCAI remains a concern in our country and globally. They prolong the hospital stay. The implementation of a prevention, control and surveillance program will improve the quality of care by significantly reducing HCAI.

[Health-care related infections in pediatric surgery of the teaching hospital Gabriel Toure, Bamako, Mali]

OBJECTIVES

to identify the main causative agents of infection associated with care and their susceptibility to antibiotics used and to identify risk factors for care-associated infection.

MATERIAL AND METHODS

This was a cross-sectional study with prospective data collection, conducted from 1 November 2016 to 1 April 2017 among all children admitted to the pediatric surgery department. Non-consenting parents and cases of necrosectomy were included in this study.

RESULTS

Our study involved 200 patients, 30 of whom presented a care-associated infection (15% infection rate). The average age of patients with infection was 56.33 ± 48.66 months (1 and 180 months). The main pathogens responsible for infection of the operative site were: Escherischia coli (4 cases), Acinetobacterbaumanii (3 cases), Klebsiella pneumoniae (2 cases), Staphylococcus aureus (2 cases), Enterobacter cloacae (1case), Pseudomonas aeruginosa (1 case) and Enterobacter faecalis (1 case). In the burned patients, the organisms found were: Acinetobacter baumanii (7 cases), Klebsiella pneumoniae (6 cases), Staphylococcus aureus (6 cases), Escherischia coli (4 cases), Pseudomonas aeruginosa (2 cases) and Enterobacter faecalis (2 cases). Escherichia coli was noted in urinary tract infection. Antibiotics tested were amoxicillin, amoxicillin-clavulanic acid, ceftriaxone, imipenem, gentamicin and ciprofloxacin. The mode of recruitment and the duration of hospitalization were the risk factors noted.

CONCLUSION

The infection associated with care is a frequent occurrence in our practice. These infections mainly occur at the operating sites. The germs found were: Acinetobacter, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus. They are all sensitive to imipenem and resistant to amoxicillin. The infection remains formidable in health care. It is essential to give special attention to the prevention of infectious risk, especially in the surgical setting.

[Ct scan diagnosis of polyostotic fibrous dysplasia with maxillofacial dysmorphia: a case report]

We report a rare case of polyostotic fibrous dysplasia with maxillofacial dysmorphia diagnosed in the radiology department at Hopital Sominé Dolo of Mopti. The aim was to describe the role of medical imaging including the CT scan in its diagnosis. He was a 42-year-old man of rural origin with poor socio-economic conditions. He was sent to us for a craniofacial CT scan for assessment of a maxillofacial mass. This CT scan showed a thickening of the diploid of the vault and the cranial base with osteocondensation and osteolytic lesions at the maxillofacial level. An extension assessment showed polyostotic involvement. His diagnosis is based on medical imaging and in particular CT scan. Three types of radiological aspects are evocative: a homogeneous or heterogeneous clarity, a smoke-like appearance and a slightly condensed appearance. Complications observed were deformities, fracture of the femoral neck and aesthetic damage.

[Surgical site infections at Bocar Sidy Sall University Hospital Center of Kati]

INTRODUCTION

Surgical site infections (SSI) are frequent and dangerous in the surgical ward. They represent an obsession for the surgeon. The objectives were to determine the frequency of ISOs and risk factors, to identify the germs and to study their sensitivity to different antibiotics.

MATERIALS AND METHODS

This was a cross-sectional study with prospective data collection, performed at the general surgery department of the Bocar Sidy Sall University Hospital Center (Kati CHU) from January 2015 to December 2018.

RESULTS

During this period of study we recorded 55 cases of ISO out of 650 operated patients with a frequency of 8.46%. 450 patients were operated on the cold operating program (69.23%) and 200 patients on emergency (30.77%). The average age was 39, the sex ratio was 2.66. Among the 55 cases of ISO, 60% of these patients were operated in emergency and 40% in the operating program. The most common strains found were Escherichia coli (E. coli) in 38.3% of cases, Staphylococcus aureus in 23.4% and Klebsiella pneumonia in 13.3%. Hemoglobin levels were normal in 70% of cases. 4 of our patients or 7.27% were diabetic. We did not have any cases of obesity. Of the 55 cases of ISO, 66% were of class 3 and 4 of Altemeier, 59% were of ASA score 2 and ASA 3, 55% were of score 2 of NNISS (National Nosocomial Infection Surveillance System), 5.45% were NNISS score 3 or 3 cases and these 3 cases developed ISO. The ISOs were parietal in 49 cases, ie 89%. The recovered germs were 100% sensitive to imipenem. The most informative interventions of the ISOs were peritonitis 25 cases (45.45%), intestinal occlusions 12 cases (21.82%), appendicular abscess 8 cases (14.55%). We had 2 death cases, 3.64%, the average hospital stay was 13 days.

CONCLUSION

Escherichia coli was the common germ found in the ISO in general surgery at Kati BSS Hospital. The usual resistance to antibiotics must provoke effective preventive actions.

[Dynamics of Egg Excretion of Schistosoma haematobium in a Longitudinal Cohort Under Treatment with Praziquantel over a Five-Year Period in Kalifabougou, Mali]

This study aim was to evaluate the dynamics of Schistosoma haematobium eggs excretion after the scaling up of "Mass Drug Administration" (MDA) with praziquantel (PZQ) from 2011 to 2016 in a cohort of volunteers living in the village of Kalifabougou, Mali. We conducted a cross-sectional study on 676 volunteers in May 2011 niched in cohort study from 696 volunteers aged three months to 25 years. The eggs of Schistosoma haematobium (Sh) were tested by urine filtration technique, Soil-transmitted helminth and Schistosoma mansoni by the Kato-Katz technique. Maximal MDA/ PZQ population coverage was 83% in 2015 and no MDA/PZQ n 2014. A total of 676 volunteers was included in this prospective cohort. The prevalence rate of Sh showed a significate decreasing from 2011, 2013 to 2014 with respectively 10.2% [95% CI=10.04-10,18], 5.32% [95% CI=5.30-5.33], and 5.25% [95% CI=524.-5.31], followed by an increase to 10.6% [95% CI = 10.47-10.63] in 2015 and a significative decrease in 2016 to 5.4% [95% CI=3.5-7,3]. Children aged from six to 10 years and mostly boys were more infected with Sh, then could serve of parasite reservoir. MDA with PZQ remains an effective strategy for schistosomiasis control against Sh in Kalifabougou. Additional studies on MDA/PZQ average treatment covering human-water contact behaviors and population migration are necessary to understand the persistence of the 5% annual prevalence rate of egg shedding in the cohort of volunteers periodically treated with PQZ. Testing eggs shed viability will be also an added value.

[Problem Of Diabetic Foot Amputations]

INTRODUCTION

The diabetic foot wound is a real public health problem, 10% of the reasons for hospitalization. The risk of amputation is 10 to 30 times higher in diabetics than the general population.

OBJECTIVE

To study the problem of amputations of the diabetic foot.

METHOD

This was a descriptive and cross-sectional study that took place in the Department of Medicine and Endocrinology of the Mali Hospital from July 1st, 2016 to June 30th, 2017.

RESULTS

Twenty-five (25) diabetic patients were enrolled in our study. The sex ratio was 0.66. At admission, 100% of our patients had arterial disease, 96% neuropathy, and mixed foot in 80%. Poor glycemic control in 64% of patients; osteitis in 52% of cases; 92% of the patients had a 100% amputation risk according to the University of Texas classification. Nearly half or 46% of patients had amputations in the leg. We recorded 1 death case that is 4%.

CONCLUSION

The problem of amputation of diabetic feet is a function of the poor equilibrium and progressive neurological and vascular complications of diabetes.

[Study Of Immediate Post-Partum Care Satisfaction (Ssoppi) At The Reference Health Center Of The Community V Of Bamako]

The objectives of the work were to measure the degree of satisfaction of women in the postpartum period and to determine the stability of the immediate postpartum care satisfaction scale (PASS).

MATERIAL AND METHOD

The motherhood of the reference health center of commune V served as a study framework. The study was descriptive for evaluative purposes in postpartum women. It covered the period from 11 July 2014 to 14 January 2015. Two interview questionnaires (SSOPPI1) and (SF12 and SSOPPI2) were used for data collection. The data analysis was done on the software EPI-info version 3.5.3.

RESULTS

The study involved a total of 145 women in SSOPPI1 and SSOPPI2. The average age was 25.6 years ± 5.5 years. The level of satisfaction for the two phases of the study (SSOPPI1 and SSOPPI2) was a function of level of study, occupation, mode of initiation of labor, route of delivery, status of newborn at birth. Satisfaction was 98.6% in SSOPPI1 and was 98,5% in SSOPPI2 with a statistically insignificant difference (p = 0.67).

CONCLUSION

The degree of overall satisfaction was a function of a number of factors. This satisfaction remained stable during both phases of the study.

[Torsion Of Meckel's Diverticulum, A Case Report At Paediatric Surgery Service Of CHU Gabriel Touré]

Twist is the rarest complication of Meckel's diverticulum (DM). We did not find a case published in African literature. We report a case of twisted "giant" diverticulum occurred in a 15-year-old boy who had consulted for abdominal pain. Operated in emergency, the diagnosis was intraoperative. The diverticulum was 14 cm long and 5 cm in diameter. It was twisted at its base, totally necrotic and perforated at the top. We performed a resection carrying the diverticulum followed by a terminoterminal ileal ileal anastomosis. The postoperative course was simple.

[Comparative Study of Induced Pregnancies and Spontaneous Pregnancies in a Level II Hospital in Bamako District Mali]

The aim of this work was to compare the prognosis of induced pregnancies and spontaneous pregnancies received in the service.

PATIENTS AND METHODS

We performed a retrospective study of Ca / Witnesses (1 case for 2 controls) with age and parity matching. This study was conducted at the maternity ward of the Reference Health Center of Commune V District Bamako (CSREF CV) over a period of 10 years from January 1, 2007 to December 31, 2016 for all patients meeting our criteria of 'inclusion. We called cases, induced pregnancies, and witnessed spontaneous pregnancies. The data was entered and analyzed on the Epi-Info software version 6.04 according to the formula applicable to the Case / Witness study.

RESULTS

We included in this study, (due to a case for two controls), 1611 induced pregnancies (cases), and 3222 spontaneous pregnancies (controls). The average age was 35.4 years (25 years-43 years) with an average parity of 2.7 (1-5). Hypertensive disorders, preterm birth, intrauterine growth retardation (IUGR), caesarean section, poor perinatal prognosis were found with a statistically significant difference (OR> 1) in patients with induced pregnancies.

CONCLUSION

Induced singleton pregnancy is a high-risk pregnancy.

[Urethral Prolapse Of The Girl In The Service Of Pediatric Surgery Of The Teaching Hospital Gabriel Touré]

OBJECTIVES

To describe the diagnostic and therapeutic aspects of urethral prolapse in girls in pediatric surgery.

PATIENTS AND METHOD

This was a 9-year retrospective study (January 2007 to December 2015) of girls aged 0-15 years with urethral prolapse and management in the department during the study period.

RESULTS

In 9 years, 18 cases of prolapsewerediagnosed, or 2 cases / year. The averageagewas 8.9 ± 3.4 yearswithextremes of 6 years and 15 years. Of the 18 cases identified, 10 werereferred. Femalegenital mutilation wasfoundin 15 (83.3%) patients, rectal prolapsewasassociatedin 2 cases (11.1%) and a cough concept in 5 (27.8%) patients. The average consultation time was 11.6 ± 7.9 dayswithextremes of 1 and 21 days. Eleven (61.1%) patients werereceivedurgently, including 2 cases (11.1%) of strangulation. Prolapsewas in the form of a roundedswelling, centered by the urethralmeatus. The mass wasblackishin 2 cases (11.1%). Shewasbleeding and painfulin 11 (61.1%) cases. Thesesignswere absent in 5 cases (27.8%). Swellingwasassociatedwithsigns of urinarydysuria and / or urinaryblightin 10 (55.5%) girls. The diagnosiswasclinical in all patients. Treatmentconsisted of excision and suturing of the prolapsedmucosa in all patients with placement of an indwellingurinarycatheter. Immediatefollow-up was simple in 16 (88.9%) patients and 2 cases (11.1%) of surgical site infection.

[Neoadjuvant chemotherapy in locally advanced cervical cancer in patients receiving a concomitant chemoradiotherapy in a low income country]

PURPOSE

Delays to access to radiotherapy are long in our context. The purpose of this study was to analyze the effect of neoadjuvant chemotherapy to concomitant chemoradiotherapy in locally advanced cervical cancers.

PATIENTS AND METHODS

We conducted a retrospective study from April 2014 to April 2016 at the radiotherapy center of "Hopital du Mali" in Bamako, Mali. Patients were allocated according to age, histological type, tumor size and the 2002 classification of the FIGO. Experimental protocol was the administration of a neoadjuvante chemotherapy with association of Paclitaxel 175mg/m² + Carboplatine AUC 5 every 3 weeks and radiothérapy cure with avec linac 6 MV at 70 Gy due to 5 sessions of 2 Gy per week associated with a concomitant chemotherapy with cisplatin at 40 mg/m2/week. The clinical response was assessed at the end of neoadjuvant chemotherapy and of concomitant chemoradiotherapy.

RESULTS

Thirty patients were included in the study. The mean age was 53.63 ± 8.9 years. The mean size of the tumor was 5.17 cm (2 to 7 cm). According to the 2002 classification of the FIGO stages IIB were 33% (n = 10); IIIB were 57% (n = 17) and IVA were 10% (n = 3). Clinical evaluation at the end of neoadjuvant chemotherapy found: complete response 17 % (n = 5), partial response 10% (n = 3) and stable disease 73 % (n = 22). Evaluation at the end of the concomitant chemoradiotherapy had found the complete response in 90% (n = 27) and stable disease in 10% (n = 3).

CONCLUSION

Neoadjuvant chemotherapy to concomitant chemoradiotherapy in locally advanced cervical cancer allows stabilization of the tumor and improves local control. Due to long delays to access to radiotherapy treatment in our context; neoadjuvant chemotherapy is an alternative to stabilize the disease and prevent distant metastasis from locally advanced cervical cancers.

[Neonatal Gastric Perforation]

Neonatal gastric perforation (PGNN) is a rare and serious pathology when management is not early. We did not find a case published in African literature. . We report 2 cases of PGNN registered in pediatric surgery of C.H.U Gabriel TOURE. The clinical pictures were that of a neonatal occlusion. X-rays of the abdomen without preparation revealed pneumoperitoneum in both cases. Congenital origin was retained for both cases. Surgical treatment consisted of excision-suture of the perforation margins. The operative sequences were simple in both cases.

[Primary hyperparathyroidism of chance, a case study]

The authors are reporting here a documented case of hyperparathyroidism leading to hypercalcemia diagnosed spontaneously. A 75-year old female patient with has been treated since 3-4 years with metformin and ramipiril fortype 2 diabetes and high blood pressure, respectively. She was seen in our endocrinology outpatient visit for tingling in the arms associated with cervical pain with increasing intensity over the last six months. The patient's mother was diabetic and her father had high blood pressure. The diagnostic of primary hyperparathyroidism, resulting from a diffuse hyperplasia of the parathyroid gland, was retained after medical, biological, chirurgical and anatomo-pathological investigations. The blood level of PTH1-84 was 916.60pg/ml Normal value=15-68.3pg/ml.

CONCLUSION

Diffuse poly-arthralgia in the neck and the lower limbs may not always be due to arthrosis in elderlies. Further investigation such as the dosage of blood level of calcium and PTH are required.

Description of strokes at the Bouaké University Hospital, Côte d'Ivoire

INTRODUCTION

The incidence of stroke is rising in developing countries. In Côte d'Ivoire, it accounts for nearly 45 % of admissions to the neurology departments in Abidjan. In Bouaké, no study has dealt with this subject since peace returned. Our aim was to assess the epidemiological characteristics of stroke patients at Bouaké University Hospital.

METHODOLOGY

This cross-sectional study took place from September 2013 to December 2015 and included all patients hospitalized for a stroke confirmed by brain imaging.

RESULTS

The study included 164 cases: 60% ischemic strokes, and 40 % hemorrhagic. Patients' mean age was 62 years with a sex ratio of 0.66. Patients not in the labor force accounted for the largest portion (61.6 %). The interval between the stroke and admission to the neurology department ranged between 24 and 72 hours for 61 % of the patients. The main risk factor was hypertension (62.8 %). The average length of hospitalization was 8.44 days. Hospital mortality was 18.3 %.

CONCLUSION

Stroke is responsible for high morbidity and mortality in the neurology department of Bouaké University Hospital.

[Results of anastomotic urethroplasty for male urethral stricture disease]

OBJECTIVE

To report our experience with anastomotic uretroplasty (AU) due to male urethral stricture disease (USD) and to identify factors affecting the results.

PATIENTS AND METHODS

We conducted a retrospective study over a period of 4 years and 6 months (July 2012 to December 2016). Any subsequent use of endoscopic urethrotomy or new urethroplasty was considered a failure.

RESULTS

Forty-eight cases were included. The mean age of patients was 53.5±17.3 years (23-87 years). Urinary retention was the reason for consultation in 42 cases (87.5%). The most common localization of USD was the bulbar urethra (n=45). The mean length of USD was 1.23±0.62cm (0.5-3cm) with a median length of 1cm. The etiology was post-infectious in 56.3% of cases. More than half (58.3%) of patients had already undergone at least one urethral manipulation. After an average follow-up of 21.1±12.6 months (1 to 52 months), the overall success rate was 77.1%. In univariate analysis, length, cause and location of the stricture, age of patient, the presenting symptoms of the stricture, previous urethral manipulation and surgeon experience did not significantly impact on the success rate of anastomotic urethroplasty at one and two years follow-up.

CONCLUSION

The AU had provided good results in our practice. The infectious origin of the stricture and previous urethral manipulation did not significantly impact the result of this surgical technique.

LEVEL OF EVIDENCE

4.

[Appendiceal Duplication In A Patient Operated For Chilled Appendix Breastplate At Gao Regional Hospital]

Appendiceal duplication is the very rare malformation. It was first described by Picoli in 1892. It is a condition that is most often seen in the first years of life, sometimes some forms may remain asymptomatic and only occur in adulthood. We report the case of appendiceal duplication in a patient operated for chilled appendix breastplate at Gao Regional Hospital.

CONCLUSION

appendiceal duplication is a rare abnormal abnormality of intraoperative discovery in general. Each surgeon must think about it during an appendectomy.

[Bilio-Digestives Derivative In The Palliative Surgery Of Pancreatic Head Cancer At The CHU Gabriel TOURE]

OBJECTIVES

Our objective was to determine the frequency of bilio-digestive bypass in palliative surgery in pancreatic head cancers, to determine the clinical and para-clinical aspects and to analyze the results of the treatment.

METHODS

This was a-15 year retrospective study from 1999 to 2014 including any patient with confirmed pancreatic cancer in the anatomo-pathology treated by palliative surgery in the department.

RESULTS

In 15 years, we operated152 cases of cancer of the head of the pancreas. The bilio-digestive derivation was performed in 78 patients, or 51.32%. The average age was 58.61 years ± 11.22 years with the extremes of 34 and 79 years old, the sex ratio was 1.44. The disease duration was 4.88 months on average with a standard deviation of 4.28 months and extremes of 1 and 24 months. Courvoisier-Terrier's disease was observed in 76 cases with lesions of the cases. The average pancreatic tumor size was 62.98 mm, and standard deviation = 8.68 with the extremes of45 and 121 mm. We performed a choledoco-duodenal anastomosis and a gastro-entero-anastomosis (GEA) in 85.90% of cases (n = 67), a choledocojejunal anastomosis and a GEA in 7 cases and a choledoco-duodenal anastomosis without GEA in 4 cases. The morbidity and the mortality rates were15.4% and 6.41%, respectively. At six (6) months postsurgery, a complete disappearance the majority of the functional signs was observed.

CONCLUSION

Pancreatic cancer is a slowly developing tumor. Therefore its diagnosis is late; the derivation makes it possible to improve the quality of life of the patients.

[Prevalence of Malaria, Intestinal and Urinary parasite infections in Kalifabougou, Mali]

Soil transmitted helminthiasis and schistosomiasis are neglected tropical diseases (NTD), affecting the health status of endemic Malian populations. Mali has a national NTD elimination program using the mass drug administration (MDA) strategy combining Albendazole, Ivermectinand Praziquantel. Malaria still remains a public health problem in Mali. The Community health Center (CSCOM) in Kalifabougouvillage in the Kati health district has benefited from such MDA program since 2010.

AIM

To evaluate the prevalence rate of malaria, intestinal and urinary parasite infections in the local population.

MATERIEL AND METHODS

We conducted a nested cross sectional and cohort study in May 2011 on volunteers aged three months old to 25 years old. Blood smear (blood), Kato-Katz (Stools) and urine filtration techniques were used to evaluate parasite prevalence. Informed consent and assentment were obtained from the volunteers before their inclusion. All volunteers received treatment against the parasite diseases of interest according to the guidelines of national disease control programs.

RESULTS

A total of 688 volunteers were included. The prevalence rates of parasitic infections were 22.1% [95% CI= 22.06 - 22.12] for Plasmodium falciparum, 9% [95% CI: 8.9-9.034] for Schistosoma haematobium; 3.5% [95% CI: 3.48-3.513] for Hymenolepis nana and 0.1% [95% CI : 0.093-0.107] for Schistoso mamansoni. The prevalence rate of the co-infection Plasmodium falciparum - Schistosoma haematobium was 2.18% [95% CI= 2.17 - 2.19] in Kalifabougou.

CONCLUSION

Praziquantel and Albendazole-based MDA and Artemisinin based combined therapy (ACTs) could explain theobserved low prevalence of helminthiasis and malaria in Kalifabougou, Mali.

[Undesirable Events During Anesthesia For Programmed Digestive Surgery]

OBJECTIVES

to study the morbidity operative peri in digestive surgery.

PATIENT AND METHOD

It was about a prospective and descriptive survey in the services of digestive surgery and anesthesia resuscitation from February to August 2014. The population of survey was constituted of the whole patients having benefitted an anesthesia for programmed digestive surgery. The statistical test used for the comparison of the qualitative variables was CHI2 with p <0,05 considered meaningful.

RESULTS

during the period 125 files have been collected. The patients having presented at least an undesirable event were of 86 either 68,8%. These events had occurred in 77.9% of cases during the interview. The middle age was of 47.46±15, 68years with extremes of 18years. and 85 years. Sex ratio was of 1, 55. Patients were classified ASA I in 83.2%. The predominant operative indication was the gastric tumor in 26.4 % of the cases. General anesthesia was practiced in 82.4% of the cases. Anesthesia were achieved in 55.2% of the cases by male nurses' anesthetists and 44,8% by the students in diploma of studies specials(DES).Main recovered undesirable events were of cardiovascular, respiratory and digestive nature (nausea and vomiting). Intervening of the undesirable events was bound to the technique of anesthesia, Anesthetic time length of intervention, used narcotic and to the antecedents of the patients with p <0, 05.

CONCLUSION

Factors of avoidable operative morbidity peri are nearly present in all our acts for digestive surgery. The formation of the staff and the setting to disposition of products better tolerated will permit to reduce these factors.

Childhood tuberculosis in Mauritania, 2010-2015: diagnosis and outcomes in Nouakchott and the rest of the country

Setting: The National Tuberculosis Programme, Mauritania. Objective: To compare the diagnosis and treatment outcomes of childhood tuberculosis (TB) cases (aged <15 years) registered between 2010 and 2015 inside and outside Nouakchott, the capital city. Design: This was a retrospective comparative cohort study. Results: A total of 948 children with TB were registered. The registration rate was 10 times higher in Nouakchott. The proportion of children among all TB cases was higher inside than outside Nouakchott (7.5% vs. 4.6%, P < 0.01). Under-fives represented 225 (24%) of all childhood TB cases, of whom 204 (91%) were registered in Nouakchott. Extra-pulmonary TB was more common in Nouakchott, while smear-negative TB was less common. Treatment success was similar inside and outside Nouakchott (national rate 61%). The principal unsuccessful outcomes were loss to follow-up outside Nouakchott (21% vs. 11%, P < 0.01) while transfers out were more common in the city (25% vs. 14%, P = 0.01). Being aged <5 years (OR 1.2, 95%CI 1.1-1.5) was associated with an unsuccessful outcome. Conclusion: This study indicates problems in the diagnosis and treatment of childhood TB in Mauritania, especially outside the city of Nouakchott. We suggest strengthening clinical diagnosis and management, improving communications between TB treatment centres and health services and pressing the TB world to develop more accurate and easy-to-use diagnostic tools for children.

Kaposi's disease in an HIV positive child, with probable contamination from his grandmother

Kaposi's disease in children with HIV is rarely reported in everyday practice. This is a case study of cutaneous Kaposi's disease revealing HIV in a 5-year-old child with polymorphic eruption of papules and nodules on the face, trunk, back, and limbs. Histopathological examination confirmed the diagnosis of Kaposi's disease. The child's HIV serology was positive with a CD4 count of 240/mm³, normochromic and normocytic anemia, and a hemoglobin level at 8.5 g/dl. It was found that the child, after early weaning from his HIV-negative mother, had repeatedly suckled his healthy grandmother, who had no skin lesions but was HIV1 positive. Both grandmother and child were referred for treatment in their locality. The case is noteworthy for the way in which the HIV1 virus infected the child during weaning and then being suckled by his grandmother. The child already had an initial dental flare that could have injured his grandmother. Thus, in our case, there is a contamination by HIV1 virus most likely from the grandmother and contamination by the HHV8 virus, source unidentified as a technical plateau was reached.

Differences in genetic structure assessed using Y-chromosome and mitochondrial DNA markers do not shape the contributions to diversity in African sires

Up to 173 African sires belonging to 11 different subpopulations representative of four cattle groups were analysed for six Y-specific microsatellite loci and a mitochondrial DNA fragment. Differences in Y-chromosome and mtDNA haplotype structuring were assessed. In addition, the effect of such structuring on contributions to total genetic diversity was assessed. Thirty-five Y-chromosome and 71 mtDNA haplotypes were identified. Most Y-chromosomes analysed (73.4%) were of zebu origin (11 haplotypes). Twenty-two Y-haplotypes (44 samples) belonged to the African taurine subfamily Y2a. All mtDNA haplotypes belonged to the "African" taurine T1 haplogroup with 16 samples and nine haplotypes belonging to a recently identified subhaplogroup (T1e). Median-joining networks showed that Y-chromosome phylogenies were highly reticulated with clear separation between zebu and taurine clusters. Mitochondrial haplotypes showed a clear star-like shape with small number of mutations separating haplotypes. Mitochondrial-based F_ST -statistics computed between cattle groups tended to be statistically non-significant (p > .05). Most F_ST values computed among groups and subpopulations using Y-chromosome markers were statistically significant. AMOVA confirmed that divergence between cattle groups was only significant for Y-chromosome markers (Φ_CT  = 0.209). At the mitochondrial level, African sires resembled an undifferentiated population with individuals explaining 94.3% of the total variance. Whatever the markers considered, the highest contributions to total Nei's gene diversity and allelic richness were found in West African cattle. Genetic structuring had no effect on patterns of contributions to diversity.

[Prevalence of infantile haemangiomas on black skin]

INTRODUCTION

Hemangiomas are regenerative benign vascular tumors of the child, which may be of interest to all organs, most often located on the skin. The aim of our study is to determine the prevalence of haemangiomas on black skin. It is a descriptive cross-sectional study that took place from November 2015 to August 2016 at CNAM, in the department of dermatology-leprology- Venereology of Mali.

RESULTS

Of 14,810 patients seen in consultation, we received 17 cases of hemangioma, ie 0,11%. The average age was 5 months with extremes of 1 month and 60 months. Tuberous angiomas represent 82,35% of clinical forms, subcutaneous angiomas 11,76% and mixed angiomas 5,89%. In 4/17 of our patients there was an infectious complication, following an ulceration on the first day of the consultation. The average lesion size was 3,25cm with extreme 0.5cm and 8cm. The number of lesions per patient was 1 in 16 patients and 2 in 1 patient. In 10/17 patients the lesions were localized at the cephalic level, 3/17 at the trunk level, and 4/17 at the perineum.

CONCLUSION

Infantile hemangioma is a poorly reported condition on black skin. The demands for care are motivated either by the character showing lesions or by ulcerative complications. Sensitization of populations and ongoing training of health workers are needed to detect hemangiomas.

Factors associated with dog rabies immunisation status in Bamako, Mali

We conducted a cross-sectional survey in Bamako, Mali, to determine for the first time the seroprevalence of rabies virus antibodies in the dog population and people's knowledge, attitudes and practices (KAP) towards the disease and its control. Antibody detection was done with the fluorescent antibody virus neutralisation (FAVN) test, with a positivity threshold of 0.25IU/ml. We visited 2956 households in 2010 and 2011 and found 379 dogs in 279 households. Data were collected on 279 dog-owning households, on 1017 non-dog-owning households and on 311 dogs. A serum or plasma sample was collected from 98 dogs. For 26 dogs we had sufficient data to describe the antibody decline over time after rabies vaccination using a quadratic regression. Ninety percent of interviewed persons (95% CI: 85%-91%) knew about rabies. The majority of interviewees knew that rabies is transmitted from dogs to humans, and some of the characteristic clinical signs seen in rabid dogs (change of behaviour, biting, salivation) could be listed by the majority. When asked how people behave regarding a rabid dog, killing the animal was the most frequent answer (>70%). Most (65% of the non-dog-owners and 81% of the dog-owners) were aware that vaccination of dogs can prevent rabies, but only a minority of dog-owners could answer correctly at what age the dog should get a first rabies vaccination (i.e. at 3 months). There was also strong consensus among dog-owners that it is better to protect their dog from becoming rabid by vaccinating it rather than needing to treat a bitten person. Forty-five percent (n=306; 95% CI 38%-52%) of dogs were reported as vaccinated against rabies at least once, but less than half of these (59/136) had a valid vaccination card. When asked for reasons for non-vaccination, cost was the most frequent reason at 31% (95% CI: 21%-43%), while general negligence was mentioned by 15% (95% CI: 10%-24%). Approximately one third of dog-owners would not pay for vaccination. To reach a threshold of 70% of vaccinated owned dogs, vaccination should not cost more than 0.2€ (100 FCFA). The seroprevalence of rabies virus antibodies in the examined dog population was low: 24% (n=98; 95% CI 15%-36%) with titres ≥0.25IU/ml and was 46% (n=39; 95% CI 29%-63%) when only including those reported as vaccinated by their owners. A seroprevalence of 59% (n=18; 95% CI 33%-80%) was reached if the analysis included only dogs with a valid vaccination certificate. Interestingly 4/22 dogs showed titres ≥0.25IU/ml despite being reported as unvaccinated. The Rabisin^® vaccine showed generally higher IU titres than the Dog Vac Rabia^® vaccine. All animals after booster vaccination had titres ≥0.25IU/ml which was not the case in primo-vaccinated animals. For the Rabisin^® vaccine, a Kaplan Meier estimate suggested that to maintain an antibody titre of ≥0.25IU/ml for 75% of owned dogs, revaccination should be done after not more than 2.5 years. This work contributes vital information towards planning an effective dog rabies control programme for the district of Bamako.

[Ecthyma gangrenosum of the eyelid after chickenpox]

BACKGROUND

Ecthyma gangrenosum is an acute ulcer necrotic skin infection frequently caused by Pseudomonas aeruginosa. It is characterised by necrotic ulcerations circumscribed by an inflammatory halo. Lesions are normally found in the anal, genital and axillary regions. Ecthyma gangrenosum is most commonly seen in immunodepressed patients (cytotoxic chemotherapy, HIV infection, neutropenia or functional neutrophil deficiency, agammaglobulinemia). It is a rarely described complication in chicken pox.

PATIENTS AND METHODS

Herein we report the case of a girl aged 2 ½ years presenting in our dermatology department with ecthyma gangrenosum on the right upper eyelid secondary to varicella. The disease course was marked by fibrous scarring of the inner canthus with ptosis of the right upper eyelid. The retractile scarring caused disability.

DISCUSSION

There have been previous reports of the contribution of non-steroidal anti- inflammatory drugs (NSAIDs) to the appearance of necrotic cutaneous super infections during the course of chickenpox. The occurrence of such complications on an eyelid may be harmful not only for the function of the eye but it can also cause extensive aesthetic impairment. Subsequent aesthetic and functional impairment may be improved by corrective surgery.

[Ichthyosis and social stigma in Burkina Faso]

BACKGROUND

Through the story of two families presenting ichthyosis, we report the support and social integration difficulties inherent in these genetic diseases.

PATIENTS AND METHODS

Family No. 1: a 38-year-old shepherd and his wife of 25 years both had lamellar ichthyosis that had been present continually since childhood. They had had 2 stillborn infants as well as a live newborn that were all presenting lamellar ichthyosis. Family No. 2: a 45-year-old housewife was seen at our consultation with her 3 youngest children aged 8 years, 6 years and 18 months. According to the mother, at birth, all 3 children were covered with a membrane resembling plastic that crackled during movement, and they had red eyes. Examination of the 3 children revealed a clinical picture of lamellar ichthyosis with ectropion, malformed ears and brachydactyly. Although they presented delayed growth and weight development, psychomotor development was normal. There was no consanguinity between the parents.

DISCUSSION

In both families, the visible nature of the dermatosis resulted in discrimination and ostracism. The precarious living conditions of the parents and the high cost of treatment in an African setting resulted in degradation of quality of life with exacerbation of the difficulties of social integration, resulting in a lack of schooling and a bleak future for these children.