[Our experience of the sural flap with distal pedicle in the repair of foot plantar and heel of foot lesions]

PURPOSE

The sural flap has often been used to cover the weight-bearing and non-weight-bearing areas of the foot and ankle. This study reports our experience in the coverage of these defects in the foot in weight-bearing areas.

PATIENTS AND METHOD

This is a retrospective and descriptive study of 70 months. This study includes 16 patients presenting a loss of plantar substance and/or heel of the foot covered by a sural flap with a distal pedicle. The sampling technique described by Masquelet served as our reference. An increase in the length of the pedicle of at least two centimeters during the dissection made it possible to avoid any stretching or compression for the most distal lesions.

RESULTS

The average age was 35 years with a sex ratio of three in favor of men. Traumatic lesions predominated (n=10) with an average area of lesions of 68.8cm2. The average partial and total support times were 1.8 and 3.6 months respectively. We noted one case of flap necrosis. The natural evolution of the flap took place in three progressive stages: regeneration, keratinization and squamous metaplasia. Normal bipodal support and stable gait without footwear anomaly were noted in 15 cases.

CONCLUSION

The distal pedicle sural flap technique is accessible. Its reliability makes it an ideal choice for distal loss of substance to the leg and foot.

[Knowledges And Practices Of Iron Prescription By The Pediatric Ward In CHU Gabriel Touré Of Bamako, Mali]

GOAL

To assess knowledges and practices on iron prescription in pediatric ward in CHU Gabriel Touré of Bamako, Mali.

TOOLS AND METHODS

It was a prospective and transversal study canied out. We submitted questionnaire and analyzed the case history of to the children aged 1-60 months old who received iron during the study period from 1rstto 30 July 2012. The prescriptators' consent were solicited and obtained at first of all.

RESULTS

Fifty prestators were interviewed among them 10 pediatricians (20%), 31 pediatrics' resident (62 %), 2 generalists physicians (4%), 7 medical student (14%). One hundred 100 were analyzed medical records. More than half of the prestators known the need of iron in children. Thirty percent have received iron at 8 to 10mg/kg. The medication duration wasn't indicating in 92% of patients. In our context prestators well know about meaning and the needs of iron in children bout they're limited on iron food sources and iron storage.

CONCLUSION

The well theorical knowledge on indications and prescription roules on iron in children didn't escape from miss practices in its prescription. Moreover works should analyze the reasons of discrepancies.

Prédiction de la gravité de la COVID-19 à l’admission à l’aide du Score NEWS2 : étude transversale au Maroc

Introduction

Certains patients atteints de la COVID-19 sont plus susceptibles de développer une forme grave ou des complications de la maladie. Leur identification à l’admission faciliterait la prise en charge immédiate. Le « National Early Warning Score 2 » (NEWS2) est un score de stratification des risques chez les patients atteints de septicémie et de pneumonie. L’OMS et le Royal College of Physicians of London (RCP) recommandent l’utilisation du score NEWS2 dans le cadre de la COVID-19 pour la stratification du risque chez les patients. L’objectif de cette étude était d’identifier les patients ayant une forme grave à l’admission aux urgences à l’aide du score NEWS2 au Maroc.

Méthodes

Il s’agit d’une étude transversale réalisée à l’Hôpital universitaire Cheikh Khalifa de Casablanca, Maroc du 15 avril au 15 juin 2020. Seuls les patients âgés de 18 ans ou plus, avec COVID-19 confirmé par RT-PCR ont été inclus dans cette étude. Les données sociodémographiques et les manifestations cliniques à l’admission ont été collectées et le score NEWS2 a été calculé pour chaque patient. Les patients ayant une forme grave ont été définis comme étant ceux qui sont admis à l’unité de soins intensifs. La régression logistique a été utilisée pour explorer la prédiction de la gravité de la COVID-19 par le Score NEWS2.

Résultats

Au total, 134 patients ont été retenus dans notre étude avec une moyenne d’âge de 50,8 ± 17,9 dont 54,5 % étaient des hommes, 30,8 % présentaient un état grave. La moyenne d’âge dans le groupe des patients graves était significativement plus élevée que celle dans le groupe non grave (64,20 ± 12,13 versus 44,03 ± 16,66 ans ; p < 0,001). La comorbidité était significative chez le groupe des patients graves (75,6 % versus 28,1 % ; p < 0,001). La moyenne du score NEWS2 était élevée chez les patients graves comparativement aux non graves (5,9 ± 2,4 versus 1,2 ± 1,5 ; p < 0,001). Après ajustement sur les facteurs de confusion, OR ajusté = 3,03 (1,85-4,94), p < 0,001.

Conclusion

Nos résultats montrent que le score NEWS2 réalisé à l’admission permet d’identifier les patients présentant des états graves. Il pourrait fournir aux équipes d’urgence un outil complémentaire efficace de stratification des risques pour les patients gravement atteints de la COVID-19. D’autres études avec un grand échantillon seraient intéressantes pour confirmer les résultats de cette étude.

Figure : http://extranet.insight-outside.fr/upload/compte1352/Base/inscriptions_projets/image/100131-image.pdf

Anxiety and depression among HIV patients of the infectious disease department of Conakry University Hospital in 2018

Anxiety and depression continue to be significant comorbidities for people with human immunodeficiency virus (HIV) infection. The aim of this study was to determine the prevalence of anxiety and depression disorder among HIV patients at Conakry, Guinea. In this cross-sectional study, we described socio-demographic, clinical and psychosocial data related to anxiety and depression in 160 HIV patients of the University Teaching Hospital, Conakry, Guinea. The Hospital Anxiety and Depression Scale (HADS) was used for measuring depression and anxiety in the prior month. The HADS score of ⩾8 was used to identify possible cases of depression and anxiety. Multivariate logistic regression analyses were performed to identify factors associated with symptoms of anxiety and depression. The prevalence of comorbid depression and anxiety among HIV patients was 8.1% and the prevalence of anxiety and depressive symptoms among HIV-infected patients was 13.8% and 16.9%, respectively. Multivariate analysis showed that individuals having BMI ⩽ 18 (AOR = 3.62, 95% confidence interval (CI) 1.37-9.57) and who did not receive antiretroviral treatment (AOR = 18.93, 95% CI 1.88-188.81) were significantly more likely to have depressive symptoms. Similarly, having age <40 years (AOR = 2.81, 95% CI 1.04-7.58) was also significantly associated with anxiety. Prevalence of symptoms of anxiety and depression was high in these HIV patients. This suggests a need for training on the screening and management of anxiety and depression among HIV patients.

[Epidemiological, clinical profile and outcomes of chronic hemodialysis patients in the Nephrology and Hemodialysis Department of the CHU du Point "G"]

AIM

Hemodialysis is the only method of renal replacement in Mali. Purpose of this work: to study the evolution of chronic hemodialysis.

PATIENTS AND METHODS

In a retrospective study, we used the medical charts of 150 patients. The studied parameters were the epidemiology and clinic profile of patients, the risk factors, the quality and the impact of the benefits on the survival. The data were analyzed on SPSS 12.0 for Windows with p <0.05 as the significance value.

RESULTS

The mean age was 40.45 years (15 years and 77 years). Patients have a low income in 60%. The hemoglobin level was less than 9 g/l in 63.3%. Kidney vascular disease was the most frequent causes in 42%. Hyperphosphataemia was found in 38.6%. The lipid balance was disturbed in 73.9%. A central catheter was used directly in 78.7%. The mortality rate was of 37.3%. The death was due to hypertrophic cardiomyopathy in 35.5% (p = 0.002). Low hemoglobin (p = 0.0002), central catheterization (p=0.008), cardiovascular complications (p= 0.007) and hemodialysis duration (p = 0.00001) are the risk factors for high mortality.

CONCLUSION

The duration of life in hemodialysis remains linked to the complications of renal damage and early management.

Childhood brain tumors in Mali

to assess epidemiologic and clinical aspects of childhood brain tumors in Mali. a retrospective, descriptive study of children aged 0-15 years with brain tumors, conducted in the pediatrics department of the Gabriel Touré University Hospital Center in Bamako, Mali, from January 31, 2007 to December 3, 2012. In all, 41 cases of brain tumors were recorded during this period (mean: 5.5 years old; range: 1-12 years). Brain tumors were most frequent in the children aged 2-5 years (53.7%) and among boys (53.7%). Late stage at presentation was relatively frequent (34.1%) with a mean time to diagnosis of 10 months. Features of elevated intracranial pressure were the most frequent mode of revelation of primary tumors (26.8%). Supratentorial tumors accounted for 83% of the cases, and gliomas were most frequently (29.3%) identified on computed tomography. Only five patients underwent surgical tumor removal. A broader study including the other hospitals in Bamako could help to assess more accurately the epidemiology of pediatric brain tumors in Mali.

[Rachianesthesia with morphine: analgesic efficacy of the addition of clonidine or magnesium sulfate post caesarean section]

INTRODUCTION

the aim of this study was to evaluate Target the effect of the addition of clonidine or magnesium sulfate of morphine, administered through IT on the duration of analgesia after spinal anesthesia for cesarean section.

PATIENTS AND METHODS

75 women in labor, ASA I or II, proposed programmed or semi-urgent caesarean section, were included in this study. They were randomized into three groups: Group morphine or witness (GM), Magnesium Group (GMg), clonidine group (CG). The primary endpoint was the time between the completion of spinal anesthesia and the first analgesic request.

RESULTS

The time to first analgesic request was superior, 286.76 (52.25) mn in the GC and 237.40 (73.67) mnin GMg against 209.68 (36.09)mn GM (p <0.001) in connection with the literature data. The EVA average scores at rest and during exercise in the first 24 postoperative hours were lower in groups and GC GMg compared to GM. Overall satisfaction was good in parturients with no significant difference in the groups. The duration of motor block was 193.68 (33.37) min in the GC against 141.76 (29.80) min in GM and 135.92 (23.14) min in the GMg (p <0.001). We noted a significant incidence of somnolence. Hemodynamic parameters were similar between the three groups.

CONCLUSION

In parturients operated on by cesarean section under spinal anesthesia, the addition of 75 mg magnesium sulfate or 75µg clonidine 100 µg of morphine in IT prolongs significantly the duration of the first analgesic postoperatively demand and reduced scores pain 24 hours without increasing the incidence of adverse effects.

[Caracteristics Of Severe Malaria In Child From 0 To 5 Years At The Hospital Of Sikasso In Mali]

In Mali, malaria is a major public health problem. The region of Sikasso is classified according to the geo-climatic facies as a zone with a long seasonal transmission of malaria greater than 6 months.

OBJECTIVE

To describe the epidemiological, clinical and therapeutic characteristics of children aged 0- 5 years hospitalized for severe malaria in the pediatric ward of the Sikasso hospital. Variables analyzed were epidemiological, clinical, paraclinical, therapeutic and evolutionary.

PATIENTS AND METHODS

This is a retrospective, 12-month (January-December 2014) cross-sectional study of all 0-5-year-olds hospitalized for severe malaria at the Sikasso Regional Hospital.

RESULTS

The hospital frequency of severe malaria was 55.82%. The age group of 12-35 months was the most concerned (45.3%). The peak frequency was in August (21.2%). Anemic, mixed (anemia and neurological) and neurological forms were the most frequent. Artemether and quinine were the antimalarials used. The use of a blood transfusion was frequent (82.8%). The lethality was 10% and the mixed form (anemia and neurology) was the most lethal ((P<10^-6).

CONCLUSION

Malaria remains a national concern in Mali. Improving the quality of care and prevention must be a priority to reduce the lethality that remains high.

[Accidental household poisoning of the child at the Gabriel Toure university hospital center in Bamako]

INTRODUCTION

Household accidental child poisonings are frequent pediatric medical emergencies in developing countries.

OBJECTIVE

To study the epidemiological, etiological, clinical and therapeutic aspects of acute accidental domestic poisoning in children aged 0 to 15 years admitted to the pediatric emergency department of Gabriel Toure.

METHOD

This was a prospective, descriptive study that ran from January 1, 2014 to December 31, 2014. All patients aged 0 to 15 years admitted to pediatric emergencies for acute intoxication were included.

RESULTS

A hundred cases of acute accidental poisoning were collected. Children under five accounted for 94%. The majority of mothers was housewives and had custody of children (83%). Forty-nine percent of the mothers were unschooled. The place of storage of the product was indoor in 96% of cases. The product was taken by the child himself (88%). A gesture at the scene of the accident was reported in 68% of cases, the ingestion of milk (72%) and water (10%) were the first acts used. The hospital was the first resort (72%). The time between taking the product and admission to hospital was 1 to 5 hours in 58% of cases. Vomiting (37 cases), agitation (17 cases) and respiratory distress (16 cases) were the most common symptoms. Domestic products (48%) followed by drugs (33%) ranked first among the families of poisons. Caustic soda (18%) and bleach (17%) were the most commonly found intoxication products. The evolution was good with a cure without sequelae (93%).

CONCLUSION

Accidental acute intoxications to household products are common in Mali. The hospital admission deadline is still long; the actions taken by patients at the accident site often aggravate their states but are largely done by the parents before the use of health care.

Installing biosafety level 3 containment laboratories in low- and middle-income countries: challenges and prospects from Mali's experience

In Mali, the incidence of tuberculosis (TB) is estimated at 56 cases per 100 000 people, with a prevalence of multidrug-resistant TB in new cases of 1.7% (range, 0.3–3.1%) and in retreatment cases of 17% (range, 4.4–30%). Appropriate biosafety conditions for performing routine TB culture and antimicrobial susceptibility testing have been lacking. In 2015, a biosafety level 3 (BSL3) laboratory set up in a shipping container was donated to the Malian Ministry of Health and Public Hygiene to provide capacity for TB testing. This laboratory is now managed by Malian laboratory staff and is processing samples at the national level. We explain the necessary steps for establishing and running a BSL3 laboratory. Despite the acute need for functioning and sustainable BSL3 laboratories, low- and middle-income countries are faced with a complex process and must overcome many challenges.

[Factors associated to loss of follow-up in patients underwent antiretroviral therapy in an ambulatory HIV treatment center at Conakry]

BACKGROUND

Late or inadequate therapeutic management increases the risk of mortality associated with HIV/AIDS. The aim of this study was to analyze the proportion and factors associated with loss of follow-up in HIV patients who receiving antiretroviral therapy at Conakry.

METHODS

A retrospective cohort study was conducted in HIV patients aged over 15 years and who receiving antiretroviral therapy. Between August 1, 2008 and July 31, 2015, all patients managed by the ambulatory treatment center of the Guinean Women Association against AIDS and sexually and transmissible infection were included. Loss of follow-up was defined as no follow-up visit within 3 months. Kaplan-Meier curves and multivariate Cox regression models were used to analyze factors associated with loss of follow-up. Analyses were performed by using Stata 13 software.

RESULTS

614 patients aged 36.3±11.2 years, mainly females (68.4%) and living in Conakry (80.5%) were included. Among them, 104 were loss to follow-up, corresponding to a proportion rate of 16.9% (95% CI: 14.2-19.7%) or 5.79/100 person-years. The results of multivariate analyses showed that factors independently associated with loss of follow-up were malnutrition (AHR=7.05; 95% CI: 2.05-24.27; P=0.002) and CD4 cells account at the initiation of AHR (2.35; 95% CI: 1.61-6.39; P=0.016) in patients with 201-350 CD4/μL and 5.83 (95% CI: 2.85-11.90; P<0.001) in patients with less than 150CD4/μL.

CONCLUSION

Despite efforts of health care workers and free antiretroviral therapy, many patients were loss to follow-up. Multivariate analysis showed that malnutrition and low CD4 account were independently associated with loss to follow-up.

[Epidemiological and clinical aspects of prurigo in HIV infected patients in Fousseyni N'Daou hospital of Kayes, Mali]

INTRODUCTION

Prurigo is one of the most common dermatological conditions during HIV infection and AIDS. It appears as an immunosuppression marker associated with HIV infection. The study objective was to determine the prevalence of prurigo in people living with the human immunodeficiency virus (PLHIV) in Fousseyni N'Daou Hospital of Kayes, and to describe the socio-demographic aspects of patients and lesions associated with prurigo among PLHIV.

METHODS

It was a descriptive cross-sectional study included all cases of HIV infected patients with prurigo in the Dermatology-Venomology Department of Fousseyni N'DAOU Hospital from January 1, 2015 to August 31, 2015.

RESULTS

We collected 121 cases of prurigo. The hospital prevalence was 14.5% among PLHIV with 65% Female and the average age was 34.8 years old (SD: 15-81 years). The elementary lesions associated with prurigo were seropapules (40.2%), vesiculo-crusts (13%), excoriated papules (33.3%), lichenified papules (10.8%), and cicatricial lesions (2.7%). The prurigo was generalized in 68.5% of cases and localized in 31.24%. More than half of our patients had weight loss, fever, diarrhea and oral candidiasis in their medical history. Patients were infected with HIV1 in 60.03% and HIV1+ 2 in 24.3%. More than the half of our patients had a CD4 count inferior to 250 cells/mm3 at the time of prurigo diagnosis.

CONCLUSION

In our study, prurigo remains a common condition in PLHIV, particularly in patients with low CD4 counts. Early detection and rapid antietroviral therapy can reduce the frequency of prurigo in PLHIV.

[Maxillary ameloblastoma at the odonto-stomatology University Hospital in Bamako]

INTRODUCTION

The aim of this study was to determine the sociodemographic, therapeutic, pathological and clinical aspects of patients with maxillary ameloblastoma at the University Hospital of Odonto-Stomatology (CHU OS) of Bamako.

MATERIALS AND METHOD

We performed a retrospective and prospective study over three years (January 2007 - December 2010), examining cases of maxillary ameloblastoma, as confirmed by clinical, associated with radiology or anatomic pathology. Data was collected from medical records, then entered and analyzed using Epiinfo.

RESULTS

Tumor lesions were found in 55 men and 43 women with a sex ratio of 1.27. Housewives represented the majority of cases with 35.7%. Maxillary radiography was performed on 96% of patients and biopsy in 66.3% of cases. The most common anatomical location was mandibular in 89.80% of cases, with the preferred area being the mandibular symphysis in 34.7% of cases. Conservative surgery was performed in 50% of patients and radical surgery in 26.5% of cases.

CONCLUSION

This study has shown a high frequency of maxillary ameloblastoma, and the fundamental benefits of early treatment, in order to minimize recidivism.

[IgG responses to candidate malaria vaccine antigens in the urban area of Dakar (Senegal): evolution according to age and parasitemia in patients with mild symptoms]

Malaria remains a major problem in African countries despite substantial decreases in morbidity and mortality due to sustained control programs. Studies for the evaluation of qualitative or quantitative Ab responses to key targets of anti-plasmodium immunity were mostly done in rural endemic setting compared to urban area. In a cohort of 200 patients with mild malaria and living in Dakar, we analyze total and subclasses IgG responses to a panel of P. falciparum blood stage antigens: MSP1p19, MSP3, EB200, GST-5 and R23. A mean age of 15 yrs (4 to 56 yrs) and parasitemia between 0.1 to 17% were found. Levels of IgG anti-MSP3 were higher in patients with low parasitemia (≤1%) and appear negatively correlated to parasite densities (Rho =. 0.54; p= 0.021). This correlation is more significant in children (≤ 15 yrs). In addition, an increase of IgG responses against MSP1p19 is highly observed in adults having a parasitemia less than 1%. In those patients, we find that IgG1 subclasses were predominant (p <0.01). Our study shows an association between Ab responses and parasitemia. This association is dependant to IgG anti-MSP3 in children and IgG anti-MSP1p19 in adults living in urban area.

[Knowledge and practices regarding iron prescription by medical staff of the pediatric ward in the Gabriel Touré university hospital of Bamako, Mali]

GOAL

To assess knowledge and practices on iron prescription in the pediatric ward of the Gabriel Touré university hospital of Bamako, Mali.

MATERIAL AND METHODS

A cross-sectional study was carried out from the 1st to 31st July 2012 in the service. We presented the participants with a questionnaire and analyzed the medical files of children aged 1-60 months old who received an iron prescription. Each prescriber's consent was solicited and obtained prior to the study.

RESULTS

Fifty prescribers were interviewed, among them 10 pediatricians (20%), 31 pediatrics' residents (62%), 2 generalist physicians (4%), 7 medical student (14%); and 100 medical records were analyzed. More than half of the prescribers were aware of the need of iron in children, with 42% knowing about iron reserves. 8% of prescribers knew that iron absorbed through food was heme iron or non-heme iron. Thirty percent of patients received iron at a dose of 8 to 10mg/kg. Length of treatment was not indicated in 92% of patients.

CONCLUSION

In our context, sufficient theoretical knowledge and of children's iron need did not exclude bad prescription practices. Future studies should analyze the reasons of behind this discrepancy.

[Neuromalarian lesions in the pediatric unit, Gabriel Toure University Hospital (Bamako, Mali)]

INTRODUCTION

Malaria is one of the rare public health plagues which has been prevailing over centuries. It is severe around the world poverty line and remains the most widely spread disease in intertropical zones. The Afro-tropical region, which accounts for 8% of the world population, bears the heaviest malaria burden, with 80% to 90% of cases (200 to 280 millions) among which, 90% are due to P. falciparum.

OBJECTIVE

To study neuromalarian lesions in 0-15 year old children in the Pediatric Unit at Gabriel Touré, University Hospital.

MATERIALS AND METHODS

From February 2009 to January 2010 the study covered 92 children, aged 0-15 years old, with neuromalarian lesions hospitalized at the Pediatric unit of the Gabriel Toure University Hospital.

RESULTS

2230 patients were received suffering from malaria, among whom 1320 hospitalized for neuromalarian. 92 cases (6.97%) of neuromalarian lesion were identified. There were 57 boys and 35 girls, with 1.63 sex ratio. 0 to 5 years old age group was the most significant, accounting for 67.39% of subjects. Axial hypotony was the most frequent lesion encountered (65.22%). Temporary blindness was reported in six patients (6.52%). Behavior disorders were reported in seven patients (7.61%). Five patients (5.43%) were victim of hemiplegia. Axial hypotonicity was associated with aphasia in thirty-seven patients (40.22%) and peripheral hypertonia in eighteen patients (19.57%). Seven patients (7.61%) became epileptic and six (6.52%) were suffering from dystonia. Recovery effects were 50% in the short term and 73.9% in the medium term.

CONCLUSION

Despite progress made in terms of diagnosis and care, malaria still remain a fearsome pathology and source of neuromalarian lesions among which some lead to permanent disability. Early intervention and proper treatment could reduce the incidence of neuromalarian lesions.

Ebola outbreak in Conakry, Guinea: epidemiological, clinical, and outcome features

OBJECTIVES

The authors studied the epidemiological, clinical, and outcome features of the Ebola virus disease in patients hospitalized at the Ebola treatment center (ETC) in Conakry to identify clinical factors associated with death.

MATERIALS AND METHODS

A prospective study was conducted from March 25 to August 20, 2014. The diagnosis of Ebola virus infection was made on real-time PCR.

RESULTS

Ninety patients, with a positive test result, were hospitalized. Their mean age was 34.12±14.29 years and 63% were male patients. Most worked in the informal sector (38%) and in the medical and paramedical staff (physicians 12%, nurses 6%, and laboratory technicians 1%). Most patients lived in the Conakry suburbs (74%) and in Boffa (11%). The main clinical signs were physical asthenia (80%) and fever (72%). Hemorrhagic signs were observed in 26% of patients. The comparison of clinical manifestations showed that hiccups (P=0.04), respiratory distress (P=0.04), and hemorrhagic symptoms (P=0.01) were more frequent among patients who died. Malaria (72%) and diabetes (2%) were the most frequent co-morbidities. The crude case fatality rate was 44% [95% confidence interval (33-54%)]. The average hospital stay was 7.96±5.81 days.

CONCLUSION

The first Ebola outbreak in Conakry was characterized by the young age of patients, discrete hemorrhagic signs related to lethality. Its control relies on a strict use of preventive measures.

[Reasons for hospitalisation of hiv-infected children in pediatric service of the Gabriel Toure teaching hospital, Bamako]

PURPOSE

The aim of our study was to determine the reasons of hospitalization of HIV-infected children in our context and to identify factors associated with mortality in the course of hospitalization.

PATIENTS AND METHOD

Our study took place in the department of pediatrics of the Gabriel Touré Teaching Hospital. It involved all the children hospitalized between March 1st and August 31st, 2010 to whom an infection with HIV was diagnosed before or during the hospitalization.

RESULTS

Thirty seven HIV-infected children were hospitalized. The average age at admission was 46,9 months and the sex ratio was 0,76. HIV infection was discovered during the hospitalization for 29 children (78,4%). Fifteen children were orphan of at least a parent. The medical pathological history include sickle cell disease (2 cases) and tuberculosis (1 case). The great majority (91,9%) were at WHO stage 3 or 4. The main AIDS-defining events were severe malnutrition (73%) and pneumonia (45,9%). They were followed by bacterial infections (21,6%) and malaria (13,5%). An anemia was found at 85,7 % of the children.

CONCLUSION

Efforts must be made for early diagnosis and management of pediatric's HIV infection.

[Childhood acute lymphoblastic leukemia: 12 cases in Mali]

INTRODUCTION

Data about childhood acute lymphoblastic leukemia, the most common childhood malignancy in industrialized countries, are scarce in African publications. The purpose of this prospective, unicentric study were to assess the socio-demographic, clinic and laboratory characteristics of the children treated for lymphoblastic leukemia in our pediatric oncology unit in Gabriel Touré Teaching Hospital in Bamako, Mali.

PATIENTS AND METHODS

This study includes all children between 1 and 15 years old treated for cytologically documented acute lymphoblastic leukemia from January 1, 2007 to September 30, 2009.

RESULTS

A total of 12 cases including 8 boys and 4 girls (sex ration, 2) were treated during the study period. Mean age was 92 months. Age was less than 4 years old in 2 cases. 5 (41,7%) were between 5 and 9 years in 5 (41.7%) and between 10 to 15 years in five. At the time of presentation, 9 patients (75%) were in a cachectic state; 10 had lymphadenopathies, splenomegaly and hepatomegaly; and 2 had neurological involvement. The delay for definitive diagnosis was 5 months in 4 cases (33,3 %) and less than 5 months in the remaining cases. Initial white blood cell count was more than 50 000/mm3 in 10 cases and less less than 50 000/mm3 in 2 cases. All patients were treated using the LAL GFAOP protocol including LAL1 in 6 cases, LAL2 in 5 and LAL3 in 1. Treatment complications were included 6 undocumented infections in 6 cases, hemorrhage in 2 and severe anemia in 4. Four patients died. At 5 years follow-up, overall survival rate was 66,7%.

CONCLUSION

A multicentric study including a greater number of children is needed to increase understanding of the characteristics of childhood acute lymphoblastic leukemia in sub-Saharan Africa.

Rhipicephalus (Boophilus) microplus: a most successful invasive tick species in West-Africa

The cattle tick Rhipicephalus (Boophilus) microplus is known to be a highly reproductive and efficient vector of Babesia bovis, two characters which make this tick a threat to livestock keeping in many continents. The authors identified this tick in Ivory Coast, West Africa, in 2007, and hypothesized the spread to be minimal, as this tick was not observed in previous years. To determine the extent of its distribution and to a lesser extent the possible impact of the tick on the livelihoods of Ivorian smallholders, a cross-sectional survey was carried out in the Abidjan and Agboville Departments of Ivory Coast, in April 2008. The results of the study reveal that the newly introduced tick has almost completely displaced all indigenous Rhipicephalus (Boophilus) species in the study area and gave rise to unsuccessful tick control, inappropriate pesticide use, loss of milk production and even increased mortality in dairy cattle.

A case of middle-ear angiosarcoma

INTRODUCTION

Middle-ear angiosarcoma is a rare malignant tumor that requires early diagnosis to allow satisfactory removal. The objective of the present study was to describe and discuss the diagnosis and treatment of this rare malignant middle-ear tumor.

CASE REPORT

A 12-year-old girl was admitted for a left retroauricular mass and a budding left external auditory canal tumor without associated peripheral facial nerve palsy. CT scan showed a mastoid-region tumor extending to the external auditory canal with mastoid and occipital bone-loss. Tumor removal used a retroauricular approach. Postoperative diagnosis was of angiosarcoma. At 12 months' regular follow-up, there were no signs of local recurrence.

DISCUSSION AND CONCLUSION

Middle-ear angiosarcoma is a rare tumor, in which diagnosis is late because early symptoms are not specific. A multidisciplinary approach is essential for efficient management.

[Brain trauma at the Teaching Hospital Gabriel Touré]

AIMS

To evaluate mortality and morbidity related to brain trauma.

PATIENTS AND METHODS

It was about a descriptive study done on brain trauma patients admitted to the emergency of the teaching hospital Gabriel Touré from January to august 2004. Every patient admitted for brain trauma with ornote associated lesions was included. A p < 0.05 was considered significant. RESULTS During 8 months time 324 patients have been admitted for brain trauma. The male to female ratio was 3.1. School age and academic populations have represented 79 patients (24.4%). Brain trauma has happened in 268 cases (82.8%) in a context of public way accident. These accidents have concerned pedestrian in 42% of cases (auto-pedestrian or motorcycle-pedestrian). The morbidity rate was 11 %. Conclusion Intracerebral lesion are mostly seen in brain trauma. Being a pedestrian in an accident context may expose to brain trauma.

Neurological outcome and risk of recurrence depending on the anterior vs. posterior arterial distribution in children with stroke

We report the outcome of 46 previously healthy children with arterial ischemic stroke. After a mean follow-up of 26 months, five (11%) children suffered a recurrence and 28 (61%) were left with sequelae. The prevalence and the severity of the sequelae were similar irrespective of whether the localization of the accident was anterior or posterior. However, a recurrence was significantly more frequent in the posterior than in the anterior group (4/14 vs. 1/32; p=0.025). These observations may lead to the establishment of therapeutic guidelines according to the localization of the infarct.

[Mitral valve repair for rheumatic valve disease in children in Senegal: a review of 100 cases]

Mitral valve repair is a better therapeutic alternative than valve replacement for rheumatic valve disease in children. Repair procedures are especially well suited to developing countries where heart prostheses and life-long anti-coagulation therapy are largely unaffordable. The purpose of this study was to evaluate medium-term outcome of mitral valve repair in children in Senegal. A retrospective review was conducted in a cohort of 100 patients who underwent mitral valve repair for rheumatic mitral lesions over the 8-year period from 1999 to 2007. Mean age was 12 +/- 5 years (range, 7 to 17 years). The most common symptom of valve disease was dysypnea (stage IV in 26 cases and stage III in 74). Valve lesions were complex with anterior leaflet prolapse in 62 cases, posterior leaflet restriction in 35, commissural fusion in 30, and fusion of chordaes in 54. Repair procedures consisted of transfer and shortening of chordaes in 73 cases in association with commissurotomy in 22 cases and cleft closure in 17. Ring annuloplasty was performed in 84 patients. Hospital mortality was 2%. Postoperative morbidity was characterized by residual mitral regurgitation in four cases. Mean follow-up was 5 years. No late deaths were observed. Outcome was satisfactory in 84 patients with low-grade mitral regurgitation (grade I-II). Reduction of left ventricle diameter was statistically significant during systole and diastole, i.e., from 29.5 +/- 6.2 mm to 33.1 +/- 5.3 mm (p<0.05) and from 47.1 +/- 8.6 mm to 50.5 +/- 9.4 mm (p<0.05) respectively. Improvement in cardiac function was not significant, i.e., from 63.3 +/- 4.8% to 62 +/- 6.4% (p = 0.99). Mitral valve repair was successful in stabilizing myocardial function and remodeling the left ventricle. Outcome is dependent on careful patient selection and evaluation of lesions. Middle-term outcome is encouraging.

Effect of processing parameters on the formation of spherical multinuclear microcapsules encapsulating peppermint oil by coacervation

The gelatin/gum arabic multinuclear microcapsules encapsulating peppermint oil were prepared by coacervation. The effect of various processing parameters, including the core/wall ratio, wall material concentration, pH value, as well as stirring speed on the morphology, particle size distribution, yield and loading was investigated. When the wall material concentration or the core/wall ratio increased, the morphology of multinuclear microcapsules changed from spherical to irregular and the average particle size increased, the optimal wall material concentration and the core/wall ratio were 1% and 2:1, respectively. The multinuclear spherical microcapsules with desired mean particle size can be manufactured by modulating the pH value and stirring speed. The ideal preparation conditions were pH 3.7 at 400 rpm of stirring speed. The yield of multinuclear microcapsules encapsulating peppermint oil by coacervation was approximately 90% and the processing parameters had very slight influence on the yield. When transglutaminase was used as the cross-linker instead of formaldehyde, morphology, mean particle size, yield and loading remained the same as that hardening with formaldehyde, but the particle size distribution became narrower.

[Abruptio placentae. Management in a reference Nigerien maternity. Prospective study about 118 cases during one year]

OBJECTIVE

Placental abruption is a syndrome, which occurs in the third trimester of the pregnancy or during labour. It is the main cause of pregnancy last term bleeding and is also responsible for a high stillbirth rate. The objective is to describe the epidemiological, clinical, paraclinical and therapeutic characteristics in order to decrease the fetal and maternal mortality and morbidity.

PATIENTS AND METHODS

It is a prospective and descriptive study in continuous series, over a twelve-month period, from 1st January 2003 to 31st December 2003, at Issaka Gazobi maternity of Niamey, Niger.

RESULTS

During the study period, 3255 deliveries have been done. One hundred and eighteen placental abruptions have been observed, which corresponds to a frequency of 3.6% with the highest rate during raining season. The average age and parity were: 31 years and 5th with a predominance of grand multiparous (38.2%). The majority of the patients were in-utero transfers (83,1%) and had done at least 10 km before arriving. One hundred and eleven patients had a caesarean section (94,1%) and 7 delivered through the vaginal route (5.9%). The fetal prognosis was characterized by a high stillbirth rate of 71.3% (87/122), fetal hypotrophy (64.8%) and prematurity (23.8%). The main cause of maternal morbidity was anaemia (76.3%) and Disseminated Intravascular Coagulation (5.9%). Further, 81 patients have been transfused (68.7%). The maternal mortality was 5.1% (6/118).

DISCUSSION AND CONCLUSION

Placental abruption, a medical and obstetrical emergency, is a serious obstetric condition, especially in our country. Physicians must be aware that patients with high blood pressure, preeclampsia, eclampsia, particularly in case of multiparity are at increased risk of placental abruption. Early diagnosis, prenatal follow-up and caesarean section improve the maternal and fetal prognosis.

[Uro-genital schistosomiasis with S. haematobium and infertility in Niger. Prospective study of 109 cases]

Schistosomiasis represents the second most endemic diseases following malaria. It is now endemic in 76 countries of the world, and it is estimated that more than 200 million persons are infected. The objective of this work is to help in the improvement of knowledge about Female Genital Schistosomiasis (FSG) effects on the women reproductive. A transversal prospective survey during six months, on women consulting for infertility in the health reproductive center of Niamey. The women included (109 persons) have been asked and consulted in gynecology, cervical smears urine pathology, urine ragent strips test, vesico-renal and gynecologic trans-abdominal ultrasound, hysterosalpingography (HSG) and cervical biopsy on infected patients. The infestation prevalence at S.haematobium was 38,5%. The infected persons have presented more gyneco-obstétrical symptomatology than the non infested ones. The proportion of exocervicite was 31,0% by clinical examination. The cervical biopsy done on 26 bilharziosis patients confirmed the frequence of highs chronic exocervicites (50%) and leucoplasia (11,5%). Echography and HSG noticed that the bilharzios patients can let develop other annexiel pathologies such as: ovary cyst, peri-tuboovary adhesions and wide ovaries. The symptomatology felt by infested women showed the parasitose consequence on women in endemic area. The treatment in o large schaddle by the national program allows to reduce morbidity caused by that infection in Niger.

[Clinical and tomographic aspects of 29 cases of phakomatosis in Guinea]

The purpose of this report is to describe 29 cases of phakomatosis including 18 cases of tuberous sclerosis (Bourneville) and 11 cases of neurofibromatosis (von Recklinghausen) observed over a 10-year period at the Neurology Department of the University Hospital Centre in Conakry, Guinea. Findings during this period were consistent with those classically reported in the literature: high frequency of advanced skin lesions coalescing into massive tumours, occurrence of seizures of all types and development of a wide variety of complications as a result of late diagnosis. Our experience underscores the need for follow-up and surveillance of these patients by somatic studies based on neurological, ophthalmologic and tomographic data depending on clinical findings.