[Internal Hemorroïd Disease In Digestive Endoscopy Center Of Chu Gabriel Toure Of Bamako]

the goal of this study was to investigate the internal hemorroid disease in our endoscopic center.

METHOD

This transversal study went from December 2011 to December 2012.

RESULTS

Sixty cases of internal hemorroid desease were enroled with36 men and 24 women and a middle age of 47 ±14.4 years. Clinical signs were frequently: bleeding (66.7%), constipation (58.4%), anal pain (58.3%) and hemorrhoid prolapsed (18.3%). The anal and rectum scopy found only internal hemorrhoid in 78.4% of cases and the grade I was about 81.7% of cases. All patients were beneficied of medical treatement.

CONCLUSION

hemorrhoid disease is a frequent pathology in general population mainly around third decade.

[Covid-19 And Surgical Pathologies In General Surgery Of CHU Gabriel Toure Of Bamako]

INTRODUCTION

The pure digestive form of COVID-19 is possible and initially considered rare. Our objectives were to determine the frequency of COVID-19 in patients treated in general surgery, identify the circumstances of COVID-19 discoveries in surgery, describe the post-operative complications in patients operated on COVID-1919 and describe the reorganization of post-operative COVID-19 diagnosis management.

MATERIALS AND METHODS

We conducted a prospective descriptive study from March 2020 to August 2021 (18 months). All patients who have been operated on, hospitalized or consulted in the department, the Emergency Department (ERS) or other CHU-GT departments for surgical pathology with COVID-19 or infected with COVID-19 while hospitalized were included in the study.

RESULTS

23 cases collected, representing 8.91% (23/258) of COVID-19 cases identified, a frequency of 1.27/month. The age group 66-75 was the most affected, the average age was 49.13 18.75 years, the predominance was male (sex ratio of 1.3). More than 34.78% were recruited at the SAU, 16 patients (69.56%) consulted in emergency, and digestive signs of COVID-19 were: Abdominal pain 20 cases (89.96%), anorexia 19 cases (82.61%), vomiting 8 cases (34.78%) and diarrhea 3 cases (13.04%). The pulmonary signs of COVID-19 were: Cough 18 cases (78.26%), chest pain 15 cases (65.22%), and dyspnea 9 cases (39.13%). Manifestations of COVID-19 were: pulmonary 9 cases, digestive 9 cases, associated 3 cases, incidental discovery 2 cases. The diagnostic mean was Thoracic CT (100%), Test-PCR 14 cases (60.86%) with a positive PCR test in 50% of cases. Surgical pathologies were surgical emergencies in 7 cases (30.43%), cancers in 6 cases (26.09%), COVID-19 digestive event (30.43%) and other 3 cases (13.04%). More than half of patients were operated on 12 cases (52.17%). The overall mortality was 60.87% and the mortality of surgical patients was 41.67%.

CONCLUSION

The infectious risk of COVID-19 during hospitalization, during or after digestive surgery is a real and potentially serious risk for the patient and caregivers.

Therapeutic efficacy of artemether-lumefantrine and artesunate-amodiaquine for the treatment of uncomplicated Plasmodium falciparum malaria in Mali, 2015-2016

BACKGROUND

The current first-line treatments for uncomplicated malaria recommended by the National Malaria Control Programme in Mali are artemether-lumefantrine (AL) and artesunate-amodiaquine (ASAQ). From 2015 to 2016, an in vivo study was carried out to assess the clinical and parasitological responses to AL and ASAQ in Sélingué, Mali.

METHODS

Children between 6 and 59 months of age with uncomplicated Plasmodium falciparum infection and 2000-200,000 asexual parasites/μL of blood were enrolled, randomly assigned to either AL or ASAQ, and followed up for 42 days. Uncorrected and PCR-corrected efficacy results at days 28 and 42. were calculated. Known markers of resistance in the Pfk13, Pfmdr1, and Pfcrt genes were assessed using Sanger sequencing.

RESULTS

A total of 449 patients were enrolled: 225 in the AL group and 224 in the ASAQ group. Uncorrected efficacy at day 28 was 83.4% (95% CI 78.5-88.4%) in the AL arm and 93.1% (95% CI 89.7-96.5%) in the ASAQ arm. The per protocol PCR-corrected efficacy at day 28 was 91.0% (86.0-95.9%) in the AL arm and 97.1% (93.6-100%) in the ASAQ arm. ASAQ was significantly (p < 0.05) better than AL for each of the aforementioned efficacy outcomes. No mutations associated with artemisinin resistance were identified in the Pfk13 gene. Overall, for Pfmdr1, the N86 allele and the NFD haplotype were the most common. The NFD haplotype was significantly more prevalent in the post-treatment than in the pre-treatment isolates in the AL arm (p < 0.01) but not in the ASAQ arm. For Pfcrt, the CVIET haplotype was the most common.

CONCLUSIONS

The findings indicate that both AL and ASAQ remain effective for the treatment of uncomplicated malaria in Sélingué, Mali.

[Management of patients with Covid 19: analysis of prescription drugs at Gabriel Touré University Hospital]

COVID-19 was declared a pandemic in March 2020. For case management, Mali has created several treatment sites including the site of the CHU Gabriel Touré.

AIMS

The objective of the study was to analyse drug prescriptions for the COVID-19 treatment at the CHU Gabriel Touré.

METHODS

We performed a retrospective and descriptive study from April to September 2020. Drug prescriptions and hospital records were used to collect data. Prescriptions and hospital records were used to collect data.

RESULTS

A total of 29 patients were hospitalized. The median age was 44 years, 75.90% of patients had at least one pathology associated with COVID-19. The number of prescriptions was 333 comprising 870 lines of prescriptions including 33.21% for standard treatments, and 66.79% for associated pathologies. with 86.23% available at the Hospital Pharmacy. Chloroquine, dosed at 250mg, was administered at 500mg twice a day. The national guidelines from the treatment of COVID-19 recommends 200mg of chloroquine in two doses. Vitamin C was prescribed for all patients although not included in the national guidelines. The class of drugs for the blood and blood-forming organs was the most prescribed (31.49%). The average cost of treatments was 65,602 ± 106,858 FCFA with a maximum of 567,860 FCFA. An evaluation of prescriptions in other treatment sites is necessary.

[Management of addictions at the University Hospital Center Point G, Bamako-Mali]

OBJECTIVE

To evaluate the health impact of drug use among patients in care in the psychiatric unit of the University Hospital Center Point G.

METHOD

This was a prospect in description study of drug users admitted to the G-UHC for care. From January to July 2018. It was performed in the Psychiatry Department of the University Hospital Center Point G in Bamako, which is the only structure in Mali that deals with addiction.

RESULTS

Our results show that young people in the 20-30 year group were the most affected. Cannabis was the most consumed, followed by Alcohol, and Tramadol Hydrochloride. There were cases of poly-drug abuse as well as new forms of consumption. Drug use has multiple negative consequences on health and social life: addiction, psychopathological disorders.

CONCLUSION

Substance abuse of drugs is a reality that is gaining momentum in Mali. Our study have demonstrated its sanitary impact among patients with adduction. The fight against the use of drugs requires the combined efforts of all the actors involved.

[Comparison of the performance of viral load screening from plasma and from the oneblotting paper (Oudried Blood Spot), protocol in people living with the human immunodeficiency virus (PLHIV) in Bamako]

INTRODUCTION

The use of blotting paper as a support for quantification of viral load could improve the virological monitoring of patients on Human Immunodeficiency Virus treatment in Mali. The urgency is obvious to us that the coverage in charge is only 10% for the achievement of the 3rd 90.

OBJECTIVE

To assess the performance of viral load screening (sensitivity, specificity, concordance) of DBS from the one spot DBS protocol according to plasma in people living with the human immunodeficiency virus (PLHIV) in Bamako.

METHODS

A total of 130 blotting papers were made from blood samples received from five sites for monitoring live persons with HIV. These blotting papers thus made were analyzed with the Abbott m2000 apparatus for the purpose of quantifying the viral load with plasma as reference sample. The extraction was done with the m2000SP automatic extractor, following the protocol 1.0 mL HIV-RNA DBS Protocol for paper. Furthermore, the extraction of plasma RNA on the m2000SP was done according to the 0.6 mL HIV-1 RNA protocol.

RESULTS

With 130 samples with detectable viral loads, we obtained a correlation of r = 0.837 (p <0.001). In addition, the average difference between the viral load on blotting paper and plasma was 0.512 log / virological copies with a kappa coefficient = 0.708. The threshold of 1000 copies / mL defined as virological success in our study allowed us to obtain a sensitivity of 87% and a specificity of 100%.

CONCLUSION

Decentralized zones or virological plasma monitoring is not accessible, the new Protocol one spot of Abbott laboratory offers an interesting opportunity for the follow-up of these patients with good performance at the threshold of 1000 copies. The use of DBS as a virological support can contribute effectively to the achievement of the 3rd 90.

[Epidemiology of Covid-19 and high blood pressure association at Mali'shospital]

INTRODUCTION

High blood pressure is a major cardiovascular risk factor. Patients with cardiovascular risk factors are at risk of developing COVID-19. The objective of this study was to determine epidemiology of Covid-19 infected in patients with high blood pressure.

PATIENTS AND METHOD

Descriptive cross-sectional study from April 2020 to June 2020 about patients hospitalized for Covid 19 by PCR diagnosis at the Hopital du Mali Bamako and having high blood pressure. Admission registry and patient charts were used to collect data.

RESULTS

We collected 78 out of 484 in patients which mean hospital frequency of 16.11%. The mean age was 55.21 +/- 14.61 years. Sex ratio M / F was 1.36. Patients were followed for high blood pressure in 59% of cases. Medical history was ischemic heart disease in 2.6% and dilated cardiomyopathy in 2.6%. Main functional signs were cough in 41.02% and lost of taste in 11.53%. High blood pressure on admission was grade 2 in 37.2% and grade 3 in 3.8%. Treatments received were calcium channel blockers 41.02%, inhibitors of the reninangiotensinaldosterone system 16.66% and combinations 15.38%. Hospital mortality was 10.3%. There was no statistically significant difference in mortality between known hypertensive patients and de novo hypertensive patients. There was also no statistically significant difference in mortality by grade of hypertension.

CONCLUSION

High blood pressure can be associated to Covid 19. Treatment is based on calcium channel blockers and reninangiotensinaldosterone system inhibitors. It has an impact on the prognosis of the disease with significant mortality.

[Foreskin Cyst After Circumcision At The Hospital Of Sikasso (MALI)]

Cyst scar post circumcision of the stump of the prepuce is pathology of which we have not found any cases in the literature. The circumcision traditional is still practiced in our regions with its attendant complications, in particular, the high section, the whole or part of the gland, infections. The case we report concerns a patient 24 years of age, having a large cyst of 8cm diameter, evolving for the past 17 years. The patient has not informed his parents that when the desire to marry has become very pressing. The consultation was motivated by the psychological trauma, the discomfort and the pain caused by the infection, and the fistulisation. The treatment was surgical with bedroom suites. This observation underscores the importance of the knowledge of good surgical technique in order to minimize complications; it also sheds light on the taboo side of the pathologies the sphere uro-genitale.

Rice bran supplementation modulates growth, microbiota and metabolome in weaning infants: a clinical trial in Nicaragua and Mali

Rice bran supplementation provides nutrients, prebiotics and phytochemicals that enhance gut immunity, reduce enteric pathogens and diarrhea, and warrants attention for improvement of environmental enteric dysfunction (EED) in children. EED is a subclinical condition associated with stunting due to impaired nutrient absorption. This study investigated the effects of rice bran supplementation on weight for age and length for age z-scores (WAZ, LAZ), EED stool biomarkers, as well as microbiota and metabolome signatures in weaning infants from 6 to 12 months old that reside in Nicaragua and Mali. Healthy infants were randomized to a control (no intervention) or a rice bran group that received daily supplementation with increasing doses at each month (1–5 g/day). Stool microbiota were characterized using 16S rDNA amplicon sequencing. Stool metabolomes were analyzed using ultra-high-performance liquid-chromatography tandem mass-spectrometry. Statistical comparisons were completed at 6, 8, and 12 months of age. Daily consumption of rice bran was safe and feasible to support changes in LAZ from 6–8 and 8–12 months of age in Nicaragua and Mali infants when compared to control. WAZ was significantly improved only for Mali infants at 8 and 12 months. Mali and Nicaraguan infants showed major differences in the overall gut microbiota and metabolome composition and structure at baseline, and thus each country cohort demonstrated distinct microbial and metabolite profile responses to rice bran supplementation when compared to control. Rice bran is a practical dietary intervention strategy that merits development in rice-growing regions that have a high prevalence of growth stunting due to malnutrition and diarrheal diseases. Rice is grown as a staple food, and the bran is used as animal feed or wasted in many low- and middle-income countries where EED and stunting is prevalent.

[Hepatic Amoebic Abscess: Clinical Aspects And Prognosis At CHU De Gabriel Touré De Bamako]

The main goal of this study was to analyze hepatic amoebiasis abscess at the service of gastroenterology of CHU Gabriel Touré, Bamako- Mali.

MATERIAL AND METHOD

It was longitudinal and prospective study from January 2013 to February 2014 and concerned patients having hepatic abscess diagnosed by echography and amoebic serology or chocolate pus finding.

RESULT

During the study the frequency of disease was 2.4% (24/970). The sex-ratio was 2 with a mean age of 36.8±10.9 years. Smoking was observed in 58.8% of cases. Abdominal pain, fever and hepatomegaly were found respectively in 87.5%, 83.3% and 79.3% of patients. The abscess was mainly located in right lobe. HIV serology was performed among 18 patients and was negative in all cases. The medical treatment by the metronidazol was systematically proposed and was associated to abscess tap in 42.2% of patients. A total recovery was observed in 23 patients and 1 patient was died by abscess rupture in the peritoneum.

CONCLUSION

An early management cans evord complication.

[Uper Digestive Tractus Caustic Injuries In Adult Patient In Bamako: Epidemiological, Semiological And Prognostic Aspects]

The main objective of this longitudinal and prospecting study from February 2013 to January 2014 was to analyze uper digestive tractus caustic injuries in adult patients at the service of gastroenterology of CHU Gabriel Touré Bamako-Mali.

PATIENTS AND MÉTHOD

We include patients (age more than 16 years) hospitalized for digestive caustic injuries.

RESULTS

During the period a hospital frequency was 2.1% (20/970). The mean age was about 33.1 ± 9 years. Over toxic substances was discovered in 45 % of patients. The caustic ingestion was intentional in 18 patients. Psychoaffective disorders were the main reason of caustic consumption. At the entry haematemesis was the main sign. The endoscopic lesions were in majority at stage IIIb of the Zargar et al classification. A case of inhalation pneumonia, a case of digestive perforation and 6 cases of digestive obstruction were the main complications of the caustics injuries. Early death was found in 3 patients.

CONCLUSION

Upper digestive tractus caustic injuries are more and more met in our context. Preventive measures are necessary to prevent these serious lesions.

[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.

AQ-13, an investigational antimalarial, versus artemether plus lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria: a randomised, phase 2, non-inferiority clinical trial

BACKGROUND

Chloroquine was used for malaria treatment until resistant Plasmodium falciparum was identified. Because 4-aminoquinolines with modified side chains, such as AQ-13, are active against resistant parasites, we compared AQ-13 against artemether plus lumefantrine for treatment of uncomplicated P falciparum malaria.

METHODS

We did a randomised, non-inferiority trial. We screened men (≥18 years) with uncomplicated malaria in Missira (northeast Mali) and Bamako (capital of Mali) for eligibility (≥2000 asexual P falciparum parasites per μL of blood). Eligible participants were randomly assigned to either the artemether plus lumefantrine group or AQ-13 group by permuting blocks of four with a random number generator. Physicians and others caring for the participants were masked, except for participants who received treatment and the research pharmacist who implemented the randomisation and provided treatment. Participants received either 80 mg of oral artemether and 480 mg of oral lumefantrine twice daily for 3 days or 638·50 mg of AQ-13 base (two oral capsules) on days 1 and 2, and 319·25 mg base (one oral capsule) on day 3. Participants were monitored for parasite clearance (50 μL blood samples twice daily at 12 h intervals until two consecutive negative samples were obtained) and interviewed for adverse events (once every day) as inpatients during week 1. During the 5-week outpatient follow-up, participants were examined for adverse events and recurrent infection twice per week. All participants were included in the intention-to-treat analysis and per-protocol analysis, except for those who dropped out in the per-protocol analysis. The composite primary outcome was clearance of asexual parasites and fever by day 7, and absence of recrudescent infection by parasites with the same molecular markers from days 8 to 42 (defined as cure). Non-inferiority was considered established if the proportion of patients who were cured was higher for artemether plus lumefantrine than for AQ-13 and the upper limit of the 95% CI was less than the non-inferiority margin of 15%. This trial is registered at ClinicalTrials.gov, number NCT01614964.

FINDINGS

Between Aug 6 and Nov 18, 2013, and between Sept 18 and Nov 20, 2015, 66 Malian men with uncomplicated malaria were enrolled. 33 participants were randomly assigned to each group. There were no serious adverse events (grade 2-4) and asexual parasites were cleared by day 7 in both groups. 453 less-severe adverse events (≤grade 1) were reported: 214 in the combination group and 239 in the AQ-13 group. Two participants withdrew from the AQ-13 group after parasite clearance and three were lost to follow-up. In the artemether plus lumefantrine group, two participants had late treatment failures (same markers as original isolates). On the basis of the per-protocol analysis, the AQ-13 and artemether plus lumefantrine groups had similar proportions cured (28 [100%] of 28 vs 31 [93·9%] of 33; p=0·50) and AQ-13 was not inferior to artemether plus lumefantrine (difference -6·1%, 95% CI -14·7 to 2·4). Proportions cured were also similar between the groups in the intention-to-treat analysis (28 of 33, 84·8% for AQ-13 vs 31 of 33, 93·9% for artemether and lumefantrine; p=0·43) but the upper bound of the 95% CI exceeded the 15% non-inferiority margin (difference 9·1%, 95% CI -5·6 to 23·8).

INTERPRETATION

The per-protocol analysis suggested non-inferiority of AQ-13 to artemether plus lumefantrine. By contrast, the intention-to-treat analysis, which included two participants who withdrew and three who were lost to follow-up from the AQ-13 group, did not meet the criterion for non-inferiority of AQ-13, although there were no AQ-13 treatment failures. Studies with more participants (and non-immune participants) are needed to decide whether widespread use of modified 4-aminoquinolones should be recommended.

FUNDING

US Food and Drug Administration Orphan Product Development, National Institutes of Health, US Centers for Disease Control and Prevention, Burroughs-Wellcome Fund, US State Department, and WHO.

Information about medications in the district of Bamako, Mali

The aim of our study was to investigate the quality of information about pharmaceutical products in Mali. The study surveyed 98 prescribers, 60 pharmacists, and the package inserts of a basket of 30 generic medicines, compared to those of the corresponding proprietary versions. We made a rational choice of 98 doctors from various specialties and levels of the health system and randomly selected 60 of the 215 pharmacies in the district of Bamako (Mali). A rational sampling of generic medicines provided us with a basket of 30 drug notices for the antimalarial, antibiotic, antalgic, antipyretic, and anti-inflammatory agents used most in the Republic of Mali. This study showed that the pharmaceutical industry, through its sales representatives, are the main sources of drug information and that this information is not always adequate. The study also found that the content provided with generic medicines is sometimes different from the information for the proprietary brand-name drugs.

Prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae isolated from blood cultures in Africa

Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae have been isolated from many regions of the world. Epidemiological studies are being conducted in Europe, North America, and Asia. No study has however been conducted in Africa to determine the prevalence and distribution of ESBLs on the continent. This literature review aimed at describing the prevalence of ESBL-producing Enterobacteriaceae isolated from blood cultures, as well as the ESBL genes involved at the international level. Our focus was mainly on Africa. We conducted a literature review on PubMed. Articles related to our study field and published between 1996 and 2014 were reviewed and entirely read for most of them, while we only focused on the abstracts of some other articles. Relevant articles to our study were then carefully reviewed and included in the review. The prevalence of ESBL-producing Enterobacteriaceae differs from one country to another. The results of our literature review however indicate that class A ESBLs prevail over the other types. We took into consideration articles focusing on various types of samples to assess the prevalence of ESBL-producing Enterobacteriaceae, but information on isolates from blood cultures is limited. The worldwide prevalence of ESBL-producing Enterobacteriaceae has increased over time. Evidence of ESBL-producing Enterobacteriaceae can be found in all regions of the world. Studies conducted in Africa mainly focused on the Northern and Eastern parts of the continent, while only rare studies were carried out in the rest of the continent.

Assessing Community Readiness to Reduce Childhood Diarrheal Disease and Improve Food Security in Dioro, Mali

Diarrhea and malnutrition represent leading causes of death for children in Mali. Understanding a community’s needs and ideas are critical to ensure the success of prevention and treatment interventions for diarrheal disease, as well as to improve food security to help reduce malnutrition. The objective of this study was to incorporate the Community Readiness Model (CRM) for the issues of childhood diarrheal disease and food security in Mali to measure baseline community readiness prior to any program implementation. Thirteen key respondents residing in Dioro, Mali were selected based on varied social roles and demographics and completed two questionnaires on these public health issues. The overall readiness score to reduce childhood diarrheal disease was 5.75 ± 1.0 standard deviation (preparation stage). The overall readiness score to improve food security was 5.5 ± 0.5 standard deviation (preparation stage). The preparation stage indicates that at least some of the community have basic knowledge regarding these issues, and want to act locally to reduce childhood diarrhea and improve food security and nutrition. Proposed activities to increase community readiness on these issues are provided and are broad enough to allow opportunities to implement community- and culturally-specific activities by the Dioro community.

[Internal hemorroïd disease at the digestive endoscopy center of the Gabriel Toure University Hospital of Bamako]

The goal of this study was to investigate internal hemorrhoid disease. This cross-sectional study was conducted at the digestive endoscopy center of the Gabriel Toure University Hospital from December 2011 to December 2012. Sixty cases of internal hemorrhoid disease were found - 36 men and 24 women and an average age of 47 ±14.4 years. Clinical signs were frequently: bleeding (66.7%), constipation (58.4%), anal pains (58.3%) and prolapsed hemorrhoids (18.3%). The rectoscopy found isolated internal hemorrhoids in 78.4% of cases and stage I of the illness in 81.7% of cases. All patients were given medical treatment.

CONCLUSION

Hemorrhoid disease is a frequent pathology in the general population mainly around the third decade of life.

Effects of ρ-Da1a a peptidic α(1) (A) -adrenoceptor antagonist in human isolated prostatic adenoma and anaesthetized rats

BACKGROUND AND PURPOSE

ρ-Da1a, a 65 amino-acid peptide, has subnanomolar affinity and high selectivity for the human α(1) (A) -adrenoceptor subtype. The purpose of this study was to characterize the pharmacological effects of ρ-Da1a on prostatic function, both in vivo and in vitro.

EXPERIMENTAL APPROACH

ρ-Da1a was tested as an antagonist of adrenaline-induced effects on COS cells transfected with the human α(1) (A) -adrenoceptor as well as on human isolated prostatic adenoma obtained from patients suffering from benign prostatic hyperplasia. Moreover, we compared the effects of ρ-Da1a and tamsulosin on phenylephrine (PHE)-induced increases in intra-urethral (IUP) and arterial pressures (AP) in anaesthetized rats, following i.v. or p.o. administration.

KEY RESULTS

On COS cells expressing human α(1) (A) -adrenoceptors and on human prostatic strips, ρ-Da1a inhibited adrenaline- and noradrenaline-induced effects. In anaesthetized rats, ρ-Da1a and tamsulosin administered i.v. 30 min before PHE significantly antagonized the effects of PHE on IUP. The pK(B) values for tamsulosin and ρ-Da1a for this effect were similar. With regards to AP, ρ-Da1a only reduced the effect of PHE on AP at the lowest dose tested (10 μg·kg(-1) ), whereas tamsulosin significantly reduced PHE effects at doses between 10 and 150 μg·kg(-1) .

CONCLUSIONS AND IMPLICATIONS

ρ-Da1a exhibited a relevant effect on IUP and a small effect on AP. In contrast, tamsulosin antagonized the effects of PHE on both IUP and AP. We conclude that ρ-Da1a is more uroselective than tamsulosin. ρ-Da1a is the most selective peptidic antagonist for α(1A) -adenoceptors identified to date and could be a new treatment for various urological diseases.

[Epidemiology and risk factors for voluntary intoxication in Mali]

INTRODUCTION

Voluntary intoxication is a major medical and social problem in developing countries and the most common method of suicide attempt. The purpose of this paper is to describe the main characteristics of voluntary intoxication in Mali and the risk factors associated with the outcome of poisoning. More generally, the aim is to contribute to the reduction of morbidity and mortality associated with self-poisoning.

METHODS

We conducted a retrospective descriptive study of the cases of deliberate self-poisoning recorded between 2000 and 2010 in 15 Malian hospitals.

RESULTS

884 cases of self-poisoning (233 men and 651 women) were identified during the period of study, representing 28% of all cases of poisoning reported during this period. The mean age of the victims was 23 ± 8.9 years. The available data indicate that the most common cases were suicide attempts and self-induced abortion using toxic substances (respectively 62.8% and 29% of all cases). The most common methods were drugs (74.5%), especially chloroquine (65%), followed by industrial products (9.1%). The most commonly used industrial products were hydrochloric acid (26.7%), sodium hypochlorite (bleach) (22.2%) and sulphuric acid (15.6%). The findings suggest that poisoning symptoms vary depending on the type of substance, the amount ingested and the delay before treatment. 86 of the 877 cases with known outcome resulted in death.

CONCLUSION

The number of cases of poisoning is probably underestimated since many cases remain undiagnosed and unreported.

[Acute generalized peritonitis in Sominé Dolo's Hospital of Mopti: Epidemiologic and therapeutic aspects]

Acute generalized peritonitis requires precocious diagnosis and immediate treatment.

MATERIALS AND METHODS

The purpose of this study is to determine hospital case frequency, to describe the clinical and therapeutic aspects and to evaluate the operating suites. We conducted a prospective study, lasting 16 months, from January 2005 to April 2006, looking at 40 cases of generalized acute peritonitis operated in several services, including a general surgery department, of the Sominé Dolo's hospital of Mopti.

RESULTS

We noted a hospital admittance rate of 3.1% with an average age of 26.3 years old and a 1.66 men to women ratio. Peritonitis at the Sominé Dolo hospital was dominated by intestinal perforation. The diagnosis was essentially made using the clinical approach. The treatment was medico-surgical. Operative mortality was recorded in 7 cases (17.5%) with 7 cases of inner-wall abscesses. The delay of consultations and the Mannheim score were the main factors causing bad prognostics. Excision - sutures associated with a cleansing drainage of the abdominal cavity was the most practised surgical procedure.

CONCLUSION

Mortality remains high. The two factors for a bad prognostic are the delay of consultation and the lack of means for reanimation.

[Small bowel obstruction and adhesions in general surgery at Gabriel Toure University Hospital]

The objectives were to determine the frequency, to describe the clinical, therapeutic aspects and to evaluate the cost of the assumption of responsibility of occlusions by supports and or adherences. It was about a retrospective study carried out in the department of surgery general of the CHU Hôpital Gabriel TOURE from January 1st, 2002 to December 2008. Were included in this study all the patients operated for occlusion of hail on Brides and Adherence confirmed in per operational. We colligé 659 acute obstructions of the bowels whose 100 occlusions of hail on supports and adherences is a frequency of 17,8%. They were 55 men (55%) and 45 women (45%). The sex-ratio was of 1,2. The average age was 39,7 years with the extremes varying between 15ans and 80 years. Eighty eight of our patients had surgical antecedents including 14 (16%) of surgery known méso colic and 74 (84%) of surgery under méso colic. Twelve patients had antecedents of contusion and untreated abdominal infections. Among the signs of the occlusive syndrome, the abdominal pain was found at all the malades100 (100%), the vomiting (98), the stop of the matters (88) and the gases (80). The ASP was carried out at 98 of our patients and 74 (75,5%) presented radiological images in favor of the occlusion of hail. The leading cause of occlusion was the supports (67), the supports and adherences (18) and adherences (15). The small intestine was hyperhémié chez14 patient, was necrosed among 16 patients and normal in the 70 cases. The surgical treatment consisted with a section of the support among 60 patients Adhésiolyse among 15 patients, a Adhésiolyse section among 10 patients, a résection Iléostomie among 10 patients and a résection - immediate anastomosis among 5 patients. The rate of morbidity was of 28%, it related to the infection of the operational site 18cas, the digestive dent 6cas and the eventration 4cas. Mortality was of 8%. Intermediate duration of hospitalization 14,8 days. The average costs of the assumption of responsibility were of 156.900 francs CFA.

CONCLUSION

Mortality and postoperative morbidity are not negligible. Gravity of this pathology underlines the interest of it's fast assumption.

[Omphalocele in general and pediatric surgery in Gabriel Touré]

INTRODUCTION

the omphalocèle is an evolution of the extra embryonic coulombs between the 32th and the 72th days of the pregnancy. The treatment depends on his volume. In Mali; few works were published on the omphalocèle and its treatment.

MATERIALS AND METHOD

we brought together 111 cases of omphalocèles during 8 years of study with the aim of determining the epidemiological factors and describing the clinical and therapeutic aspects.

RESULTS

49 patients on 111 were of the male and aged between 4,2 days with weight between 2500 - 3500 g. The diameter of the r snare was superior to 8 cms in 29(26,13%) cases and has benefited a conservative treatment according to Grobb. 13 patients had a rupture of the membrane. The liver has been found in 29 time (26,13%) in the sac and 35 case and associated malformation. 20 cases of death have been observed. Antenatal ultrasound found exomphalos in 9 cases. Any mother had a story of teratogenic medications and 67 mothers were multipared.

CONCLUSION

Omphaloceles are multidiscipli-nary surgical emergencies. Antenatal echogra-phy is useful for the antenatal diagnosis.

[Epidemiologic and therapeutic factors of postoperative incisional hernia at CHU Gabriel Touré]

INTRODUCTION

The incisional hernia is a frequent complication of the opened abdominal surgery. The objectives of this study were to determine the hospital frequency and the favoritizing factors, to analyze the therapeutic aspects.

MATERIALS AND METHODS

We realized a retrospective study from January, 1999 to December, 2005 in the services of general and paediatric surgery of teaching hospital Gabriel Touré. It concerned 45 cases of incisional hernia. The hernias of the abdominal wall, the abdominal and traumatic hernia were not retained.

RESULTS

The frequency was 0.52%; the average age of our patients was 37.8 years with a sex ratio of 2 in favour of the woman. The average delay of consultation was of 59 months with extremes going from 2 to 11 months. Favoritizing factors found were the parietal suppuration to 13 (28.8%) patients and the multiple interventions to 8 (17.8%) patients. The average dimension of the hernia was 9.5 cms ± 3.8 with extremes going from 5 to 14 cms. The 45 patients benefited from the cure of the hernia according to Mayo. We didn't lost any patient. 2 parietal suppurations happened post-operatively.

CONCLUSION

Incisional hernia treatment consists for Mayo's method or prosthesis. The laparoscopic surgery can reduce complications.

[Major cardiovascular risk factors according to gender in the hospital environment]

AIM

The study aims to describe cardiovascular risk factor according to gender in hospital.

MATERIAL AND METHODS

Il was a prospective study from april 2007 to march 2008 including 146 highblood pressure patients from 2 medical centre in Bamako. Gathering and analysis were performed with SPSS 11.

RESULTS

67% were female, the mean age reached 48,82. the BMI was significantly higher in female (P <0,001). Female were mainly registered between 30 and 44 years, and male between 45-59 years. Overweight and obesity were more represented in female and obesity in 30-44 years old patients. Isolated highblood pressure was found in 58,90%, 7,53% of patients had the 3 major cardiovascular risk factor

CONCLUSION

Isolated highblood pressure was by far the most frequent. Although the cardiovascular risk rises with the others associations, they were rare and don't significantly differ in each gender. The tendency to overweight and obesity in female should be confirmed by others studies.

Isolation and pharmacological characterization of AdTx1, a natural peptide displaying specific insurmountable antagonism of the alpha1A-adrenoceptor

BACKGROUND AND PURPOSE

Venoms are a rich source of ligands for ion channels, but very little is known about their capacity to modulate G-protein coupled receptor (GPCR) activity. We developed a strategy to identify novel toxins targeting GPCRs.

EXPERIMENTAL APPROACH

We studied the interactions of mamba venom fractions with alpha(1)-adrenoceptors in binding experiments with (3)H-prazosin. The active peptide (AdTx1) was sequenced by Edman degradation and mass spectrometry fragmentation. Its synthetic homologue was pharmacologically characterized by binding experiments using cloned receptors and by functional experiments on rabbit isolated prostatic smooth muscle.

KEY RESULTS

AdTx1, a 65 amino-acid peptide stabilized by four disulphide bridges, belongs to the three-finger-fold peptide family. It has subnanomolar affinity (K(i)= 0.35 nM) and high specificity for the human alpha(1A)-adrenoceptor subtype. We showed high selectivity and affinity (K(d)= 0.6 nM) of radio-labelled AdTx1 in direct binding experiments and revealed a slow association constant (k(on)= 6 x 10(6).M(-1).min(-1)) with an unusually stable alpha(1A)-adrenoceptor/AdTx1 complex (t(1/2diss)= 3.6 h). AdTx1 displayed potent insurmountable antagonism of phenylephrine's actions in vitro (rabbit isolated prostatic muscle) at concentrations of 10 to 100 nM.

CONCLUSIONS AND IMPLICATIONS

AdTx1 is the most specific and selective peptide inhibitor for the alpha(1A)-adrenoceptor identified to date. It displays insurmountable antagonism, acting as a potent relaxant of smooth muscle. Its peptidic nature can be exploited to develop new tools, as a radio-labelled-AdTx1 or a fluoro-labelled-AdTx1. Identification of AdTx1 thus offers new perspectives for developing new drugs for treating benign prostatic hyperplasia.

Stability of HIV RNA in plasma specimens stored at different temperatures

OBJECTIVES

In resource-limited countries, HIV-1 RNA quantification is usually performed in reference laboratories. Samples from remote areas are transported under suboptimal conditions. Here we evaluated HIV-1 RNA stability in plasma stored at different temperatures for 1 week.

METHODS

Blood samples collected in ethylenediaminetetraacetic acid (EDTA) and processed within 6 h of collection were tested by HIV-1 RNA quantification using Roche Cobas Ampliprep-Cobas TaqMan (Roche Diagnostics). The results were compared with matched HIV-1 RNA concentrations determined from plasma stored for 1 week at 4, 22, 30 or 37 degrees C.

RESULTS

A total of 51 samples were evaluated: 10 stored at 4 degrees C, 15 at 22 degrees C, 16 at 30 degrees C and 10 at 37 degrees C. Keeping plasma at 4, 22 or 30 degrees C for 1 week did not affect HIV RNA measurement. Compared with HIV-1 RNA concentrations determined from fresh plasma, the correlation was significant for each of the three temperatures with no RNA decay. In contrast, HIV-1 RNA levels decreased significantly when plasma was stored at 37 degrees C. The 10 samples submitted at this temperature showed a weaker correlation (rho=0.84; P=0.012) and a significantly reduced median HIV-1 RNA concentration (-0.92 log(10) HIV-1 RNA copies/mL; P=0.005).

CONCLUSION

Plasma can be saved for up to 1 week at 30 degrees C before shipping to a reference laboratory for HIV-1 RNA quantification.

Antioxidant and 15-lipoxygenase inhibitory activities of the Malian medicinal plants Diospyros abyssinica (Hiern) F. White (Ebenaceae), Lannea velutina A. Rich (Anacardiaceae) and Crossopteryx febrifuga (Afzel) Benth. (Rubiaceae)

The African flora contains numerous medicinal plants whose biological and chemical properties are incompletely known. Antioxidant and radical scavenging properties of plants are subject to intensive research. In the work described here, we have investigated the antioxidant activity of the plants Diospyros abyssinica (root bark), Lannea velutina (root bark and stem bark) and Crossopteryx febrifuga (seeds). Extracts of different polarity were assayed for radical scavenging activity, using the stable free radical diphenylpicrylhydrazyl, and for inhibition of enzymatic lipid peroxidation mediated by soybean 15-lipoxygenase. All plants investigated showed activity, but there were large differences between plants and between extracts. In general, Diospyros abyssinica and Lannea velutina were richer in antioxidants than Crossopteryx febrifuga. Lipophilic extracts were not active as radical scavengers, but did inhibit 15-lipoxygenase. Semipolar extracts (80% aqueous ethanol and methanol) of Diospyros abyssinica and Lannea velutina showed the highest activity both as radical scavengers and lipoxygenase inhibitors, and also gave the highest extract yields. These plants therefore appear to be excellent sources of antioxidants.

Determination of some toxic and essential metal ions in medicinal and edible plants from Mali

Plants are used in different ways in Mali, among those as medicine and as food. The monitoring of metals in the plants is of great importance for protecting the public from the hazards of possible toxic effects and also for informing the population about the nutritional value of the plants. The concentrations of some toxic and essential metal ions were surveyed in seven medicinal and edible plants from Mali. Dry ashing of the plant material and subsequent use of atomic absorption spectrophotometry were the analytical methodologies used. Iron, manganese, and zinc were found in high concentrations in some of the plants, i.e., 1.4 and 1.5 mg/g iron in Cuminum cyminum and Bombax costatum, respectively, 243 microg/g manganese in Hibiscus sabdariffa, and 62.8 and 67.1 microg/g zinc in Spilanthes oleracaea and B. costatum, respectively, whereas cobalt and cadmium were not detected in any of the plant material studied. The other ions detected, Cr, Ni, Pb, and Cu, were present in minor amounts, in the ranges of 2.2-17.2 microg/g for Cr, 1.6-8.1 microg/g for Ni, 0.7-5.2 microg/g for Pb, and 2.4-17.1 microg/g for Cu. From a toxicological point of view, none of these plants would be harmful for the user by taking in the plant material in the traditional manner, which is preparing an infusion of the plant using amounts not adding up to those necessary to reach a harmful level of the metal ions detected. The plants B. costatum and C. cyminum could be of interest as sources for iron for humans in the case of too low of a level of hemoglobin.

A survey of toxic plants on the market in the district of Bamako, Mali: traditional knowledge compared with a literature search of modern pharmacology and toxicology

In Mali, the empirical knowledge on plant medicine is held by traditional practioners. Scientific studies have been carried on some plants and they have confirmed their local uses, but few data are available on the toxicity of Malian medicinal plants. In the present work, we record the toxic plants used as medicines in the Bamako district, Mali, with the aim to evaluate the knowledge of traditional healers and herbalists on the toxicity of the plant used. A survey was carried out on the market places in the Bamako district and 106 healers and herbalists were interviewed. A survey of the scientific literature was conducted to verify or sustain the claimed toxicological data. Nineteen plants are arranged according to their frequency of quotation based on the questionnaire. The information includes the botanical name, literature survey on the pharmacology of the plants, the healers' knowledge on plant toxicity and its prevention by some of the healers.

[Prevention of infection in a surgical environment in the regional hospitals of Senegal]

This study evaluated the attitudes and practices of the personnel with respect to the prevention of nosocomial infections in a hospital environment. We carried out a qualitative survey of all categories of personnel between July 1998 and March 1999, at the five regional hospitals in Senegal (Thiés, Kaolack, Saint-Louis, Diourbel, and Louga). Data were collected in two ways: using a questionnaire to evaluate knowledge and by observing the attitudes and practices of the personnel. Hands were rarely washed before and after each procedure and surgical washing was often performed in poor conditions. The decontamination of soiled equipment was ineffective. Reusable instruments were washed directly with bare hands or by individuals wearing used surgical gloves. The equipment used for sterilization was dilapidated and unsuitable and the norms for sterilization were seldom respected. Circulation in the region of the operating theatre was disorganized, if not anarchic. The personnel had a high risk of contamination from blood. Biomedical waste was not decontaminated: it was collected poorly and disposed of directly into the environment. None of the sites visited had a program of waste incineration. In conclusion, at the sites visited, there is a high risk of nosocomial contamination during care and the reuse of equipment, for both the staff and the patients treated.

[Endemic dracunculiasis in new villages: re-emergence of the disease or failure of the surveillance system]

According to data sent to Bamako in March 1998 for the annual review of National Programs for the Eradication of the Guinea Worm (NPEGV), dracunculiasis was observed in 211 villages in Burkina Faso in 1997. Of this total, 110 (52 p. 100) were new villages not previously reporting dracunculiasis. A study focusing on these new villages was carried out in June 1998. The aim of the study was to evaluate the quality of the disease monitoring system and determine if endemicity was spreading to new villages. A twofold method was used first to analyze the data used in the geographic information section of the disease monitoring system and second to test the validity of this data in field surveys. Findings showed the actual number of new villages showing endemicity could be reduced from 46 p. 100 to 12 p. 100 since 67 p. 100 of the new villages had in fact previously reported endemicity but had been wrongly eliminated from monitoring records. This probably long-standing problem has been uncovered with a decrease in the number of villages showing endemicity and an increase in prevention activities. In addition this study identified several confounding factors and defects in disease monitoring and data reporting techniques. Based on this study, several recommendations were made to improve the quality of the disease monitoring system.

Surveillance for yellow fever virus in eastern Senegal during 1993

During the 1993 rainy season, 15,806 mosquitoes, including 14,304 Aedes ssp., were collected and tested for virus infection in 702 and 547 pools, respectively. Aedes furcifer (Edwards) was the most abundant species collected throughout the survey period. Yellow fever (YF) virus was detected in 187 pools: Ae. furcifer (123 isolates), Ae. taylori (Edwards) (41 isolates), and Ae. luteocephalus (Newstead) (23 isolates). A high prevalence of immunoglobulin (IgG) antibodies was found in human and simian populations. Results clearly indicated that increased sylvatic YF activity in eastern Senegal has the increased the risk of YF transmission among rural populations in West Africa. Our results showed that a minimal survey period may be effective in detecting the circulation of YF in the Kedougou area.

[Malarial indices in 938 children and adolescents in the humid savanna area of the south of Mali]

The authors draw up "paludometric indications" by studying 938 children and youths, in the Kadiolo area, a humid savanna in the south of Mali, by the end of the dry season (beginning of March). These results give a global indication of 70.6% (cases of malaria) with 94.4% of P. falciparum and 9.96% cases of gametocytic indications. The numbers obtained far from the rainy season let us think that the annual transmission of malaria is continuous with a recrudescence in the humid season explaining largely the infantile mortality. The use of Nivaquine may easily protect these populations from the risk of malaria disease.