[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.

SELECTION OF PFCRT 76T AND PFMDR1 86Y MUTANT PLASMODIUM FALCIPARUM AFTER TREATMENT OF UNCOMPLICATED MALARIA WITH ARTESUNATE-AMODIAQUINE IN REPUBLIC OF GUINEA

The use of Amodiaquine monotherapy is associated with the selection of molecular markers of Plasmodium falciparum resistance to chloroquine (pfcrt and pfmdr1). The decrease in sensitivity and the emergence of P. falciparum resistant to artemisinin-based combination therapy have been reported. Therefore, it is important to assess the impact of treatment of uncomplicated malaria with Artesunate-Amodiaquine (AS+AQ) on molecular markers of antimalarial resistance. We used standard World Health Organization (WHO) protocols to determine the in vivo efficacy of the combination (AS+AQ). In total, 170 subjects were included in the study. The molecular analysis focused on 168 dried blood spots. The aims were to determine the frequency of pfcrt 76T and pfmdr1 86Y mutations and the rates of reinfection using polymorphism markers msp1, msp2, and microsatellite markers (CA1, Ta87, TA99). Nested-PCR was used, followed in some cases by a restriction digestion. The level of P. falciparum clinical response was 92.9% (156/168) of Adequate Clinical and Parasitological Response (ACPR) before molecular correction and 97.0% (163/168) after molecular correction (P = 0.089). The frequency of mutation point pfcrt 76T was 76.2% (128/168) before treatment and 100% (7/7) after treatment (P = 0.1423). For the pfmdr1 mutation, the frequency was 28% (47/168) before treatment and 60% (6/10) after treatment (P = 0.1124). The rate of pfcrt 76T + pfmdr1 86Y was 22% (37/168) before and 50% (6/12) after treatment (P = 0.1465). Despite the presence of AS in the combination, AS+AQ selects for pfcrt 76T and pfmdr1 86Y mutant P. falciparum in Guinea.

[Therapeutic education in Mali: a training workshop for caregivers and young type 1 diabetic patients]

In March 2021, in the framework of a partnership between the Geneva University Hospitals (HUG), the Santé Diabète Organization and the Ministry of Health of Mali, a 4-day workshop training course was organized with the objective of strengthening the skills of caregivers in Therapeutic Patient Education (TPE) for children and young people with type 1 diabetes. To ensure interprofessionalism, physician-nurse pairs already working together in health structures in 7 regions of Mali participated in the training. Beyond complementarity between health professionals, the aim was to cope with the realities of the Malian health system. All activities were co-chaired by physician-nurse pairs, specialized in diabetes and in TPE. A total of 30 professionals took part in the training, which consisted of 2 days of classroom training and 2 days of hands-on training with type 1 diabetic children and their families. To build the caregivers capacity in TPE, we chose innovative approaches with activities allowing the immediate application of skills learned with various pedagogical tools. The beneficiaries are not only the professionals, but also the children, teenagers and their families, including the trainers.

[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.

[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.

[Superior lumbar hernia or hernia of GRYNFELTT, a case study]

The superior lumbar hernia or hernia of GRYNFELTT is a rare pathology. It accounts for less than 1.5% of all hernias in the abdomen. An 84 year-old man with upper right lumbar swelling. The clinical examination revealed a right upper lumbar swelling of 5 cm in diameter, soft, gurgling, reducible, impulsive to cough and expansive to intra-abdominal hyperpressure. There was no history of trauma, surgery, tuberculosis or dysuria. The diagnosis of an uncomplicated upper lumbar hernia was retained. Intra-operatively, the sac was dissected up to the hernia opening, separated from the edges of the hernia orifice and discharged. The repair was performed by suturing the back of the hernia opening with a non absorbable thread. The patient was released on day 1 postoperatively. The suites were simple.

[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.

[Dysthyroidism in children and adolescents at the Mali hospital]

INTRODUCTION

Dysthyroidism (hyperthyroidism or hypothyroidism) in children and adolescents is much rarer than in adults. The purpose of our study was to study the epidemiological, clinical, paraclinical, etiological and etiological aspects and to specify the therapeutic and evolutionary modalities of this condition.

METHOD

This was a five-year descriptive, retrospective and prospective study of children and adolescents under 18 years of age with dysthyroidism.

RESULTS

We collected 90 children and adolescents with dysthyroidism (hyperthyroidism 77.8% (n=70) and hypothyroidism 22.2% (n=20). For hyperthyroidism (n=70): the average age was 13.07 years and the sex ratio was 0.16. The family history of dysthyroidism was found in 24.3% (n=17). Clinical manifestations were dominated by tachycardia 88.57% (n=62), weight loss 87.14% (n=61), vibrating pulse 87.14% (n=61) and palpitation 81.42% (n=57). Bilateral exophthalmos was present in 70% of patients (n=49) with palpebral retraction in 51.42% (n=56). Goitre was present in 54 patients (77.1%). It was diffuse in 62.9% (n=44) and nodular in 12.9% (n=9). Basedow's disease represented the first etiology with 84.3% (n=59), followed by toxic multinodular goitre12, 9% (n=9). Sixty-eight patients (97.1%) received medical treatment with synthetic antithyroid drugs. Clinical remission was achieved in 64.3% (n=45) and 54.3% of patients were in biological euthyroidism at 6 months follow-up. For hypothyroidism (n=20): the average age was 10.70 years and the sex ratio was 0.53. Six family cases of hypothyroidism and three cases of family goitre were found. The clinical picture was dominated by signs of hypo metabolism at hypersomnia type 95% (n=19) and anorexia 75% (n=15). The skin was dry in 60% (n=12). A staturo-weight delay in 65% (n=13), behavioural disorders in 55% (n=11), weight gain in 40% (n=8) and puberty delay in 10% (n=2). Goitre was nodular in 25% (n=5) with cervical adenopathy present in 15% (n=3). Hashimoto's thyroiditis accounted for 45% (n=9) of etiologies followed by iodine deficiency disorders in 15% (n=3) and iatrogenic causes (2 cases of thyroidectomy). All patients were started on hormone replacement therapy for life. Five patients with large multinodular goiter received total thyroidectomy in addition to medical treatment. Euthyroidism was observed in 55% (n=11) of patients at 6 months follow-up.

CONCLUSION

Dysthyroidism in children and adolescents exists in our health facilities. Its management is deficient because of the technical and financial platform. Our public health decision-makers must help implement a screening strategy to facilitate faster diagnosis and treatment.

[Epidemio-clinicalappearances of care-associated infections in the resuscitation unit of Gabriel Touré teaching hospital (Bamako)]

An infection is said to be associated with care (IAS) when it occurs during or after a patient's management (PEC). A delay of at least 48 hours after admission is commonly accepted to distinguish a nosocomial infection from a community infection.in 2009, WHO estimated that 1.4 million people were sick in the world afterhospital-acquired infections. This prevalence remains largely underestimated in Sub - Saharan Africa, and particularly in Mali, which led us to initiatethiswork, whichaimed to describe the epidemiological and clinical aspects of nosocomial infections, determine their frequency and identify the germs responsible.

MATERIAL AND METHODS

This was a prospective study, over 12 months from January 1st to December 31st, 2016, in the resuscitation department of CHU Gabriel Touré. Including all patients with a temperature greater than or equal to 38 ° C occurring after at least 48 hours of admission. The data were collected through the surveycards and medical records. The input and analysis made respectivelyfrom Epi info software and the 2016 Office Pack (Word, Excel, Power Point).

RESULTS

Duringourstudy of 200 hospitalized patients we collected 35 IAS cases, aprevalence of 17.5%. The male sex was predominant with 60.5% and a sex ratio = 1.53. The average age was 34.28 ± 19.11 yearsold. The traumatized head with 10 cases (28.5%) were the most represented, followed by surgery postoperative 7 cases (20%) and burned 5 cases (14.2%). We carried out 51 samples (15 bronchial samples all positive, 13 ECBUs of which 11 positive, 7 blood cultures, one positive, 12 swabs all positive). The diagnoses retainedwere: ventilated lungdisease 12 cases (34.3%), urinary infection alone 8 cases (22.9%), 6 cases (17.1%) of surgical site infection, 6 cases (17.1%) ) of soft tissue infection and 3 cases (8.6%) of pneumopathy associated with urinary tract infection. The germs found were multidrug-resistant bacilli (BMR), for bronchial samples (Klebsialla pneumoniae, Acinetobacter baumanii, Echerichia coli). ECBU were found 08 cases of Echerichia coliand 01 case of enterococcusfaecalus, and 2 cases of association Echerichia coli and enterococcus faecalus; blood cultures: staphylococcus aureus. The swabsfound: Klebsialla pneumonia, Echerichia coli, Acinetobacter baumanii enterobacter, cloecae, Staphylococcus aureus, Providencia stuartii, Proteus mirabilis. The average duration of treatment of patients with IAS was 8 days with extremes of 2 to 15 days. The mortality was 57.1%.

CONCLUSION

This study allowed us to notice a resistance of different germs to antibiotics. It is therefore necessary to change the behavior of our health care facilities in order to meet this challenge.

[Epidemiological And Clinical Aspects Of Obesity In The Medicine And Endocrinology Service Of Mali Hospital]

INTRODUCTION

Lifestyle changes have played an important role in increasing the prevalence of obesity. The objectives were to describe the epidemiological, clinical and progressive aspects of obesity in patients of the Mali hospital.

PATIENTS AND METHOD

this is a descriptive study with retrospective collection of data from the medical records of patients hospitalized in the Medicine and Endocrinology department. Our patients benefited from weight gain, height, waist measurement and hip measurement with calculation of the body mass index.

RESULTS

the study concerned 90 obese patients out of 1515 hospitalized (5.94% of frequency). The mean age was 42 ± 5 with extremes 10 and 74. The sex ratio was 0.38. Obesity was mixed: 75.4% of men, 60% of woman; Android in 36% of men, 18% of women and the only child aged 10 had morbid obesity. The reason for hospitalization was complications of obesity in 13.30%. The psychological reactions collected were: anxiety 54.40%, indifference 40% and shame 5.60%. There were 68.90% complications including 37.80% cardio metabolic (hypertension associated in 51.10%). The lipid assessment carried out showed hyper LDLdemia: 70%; HDL hypoemia: 67.80%, hyper triglyceridaemia: 66.70%. Our patients received dietary and dietary advice. No drug or surgical treatment has been initiated despite the indication. We recorded 3.30% of deaths.

CONCLUSION

The epidemiological and clinical description, diagnosis and evaluation of the repercussions of obesity are easy in our daily practice. However, care remains insufficient due to the inadequacy of the technical platform, the lack of financial means and the prejudices of our patients (ignorance of obesity as a disease).

[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.

Repertoire of human breast and milk microbiota: a systematic review

Breastfeeding is a major determinant of human health. Breast milk is not sterile and ecological large-scale sequencing methods have revealed an unsuspected microbial diversity that plays an important role. However, microbiological analysis at the species level has been neglected while it is a prerequisite before understanding which microbe is associated with symbiosis or dysbiosis, and health or disease. We review the currently known bacterial repertoire from the human breast and milk microbiota using a semiautomated strategy. Total 242 articles from 38 countries, 11,124 women and 15,489 samples were included. Total 820 species were identified mainly composed of Proteobacteria and Firmicutes. We report variations according to the analytical method (culture or molecular method), the anatomical site (breast, colostrum or milk) and the infectious status (healthy control, mastitis, breast abscess, neonatal infection). In addition, we compared it with the other human repertoires. Finally, we discuss its putative origin and role in health and disease.

[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.

[Breast Cancer: Immunohistochemistry And Prognosis At Gabriel Touré Teaching Hospital In Bamako-Mali]

Breast cancer is the second cancer of women in Mali. Immunohistochemistry is poorly performed in our African countries.

OBJECTIVES

To describe the immunohistochemical aspect and determine the prognosis of breast cancer.

METHODOLOGY

This is a retrospective descriptive study (March 2006-July 2016) in the General Surgery Department of Gabriel Toure University Hospital in Bamako, Mali. Immunohistochemistry was performed in all patients through a collaboration of our German partners.

RESULTS

We collected 98 patients (95 women and 3 men) with an average age of 40.04 ± 13.07 years. Twenty-two patients (22.44%) had a personal history of benign breast disease. In 16 patients (16.33%), we found a family breast cancer. The most common histological types were intra ductal carcinoma with 84 (85.72%) and invasive lobular carcinoma in 9 cases (9.18%). Immunohistochemistry found a predominance of triple negative with forty nine patients (50%) followed by Luminal A subtype with 26 cases (26.23%). According to the TNM classification, 44 patients (44.90%) were received at stage III. The median survival was 60 months in the group of patients who received hormone therapy versus 28 months for the group without hormone therapy (p = 0.007).

CONCLUSION

Immunohistochemistry is essential for the adequate management of breast cancer. Its realization has allowed us to improve the prognosis of hormone-dependent 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.

[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.

[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.

Culture of previously uncultured members of the human gut microbiota by culturomics

Metagenomics revolutionized the understanding of the relations among the human microbiome, health and diseases, but generated a countless number of sequences that have not been assigned to a known microorganism¹. The pure culture of prokaryotes, neglected in recent decades, remains essential to elucidating the role of these organisms². We recently introduced microbial culturomics, a culturing approach that uses multiple culture conditions and matrix-assisted laser desorption/ionization-time of flight and 16S rRNA for identification². Here, we have selected the best culture conditions to increase the number of studied samples and have applied new protocols (fresh-sample inoculation; detection of microcolonies and specific cultures of Proteobacteria and microaerophilic and halophilic prokaryotes) to address the weaknesses of the previous studies^3-5. We identified 1,057 prokaryotic species, thereby adding 531 species to the human gut repertoire: 146 bacteria known in humans but not in the gut, 187 bacteria and 1 archaea not previously isolated in humans, and 197 potentially new species. Genome sequencing was performed on the new species. By comparing the results of the metagenomic and culturomic analyses, we show that the use of culturomics allows the culture of organisms corresponding to sequences previously not assigned. Altogether, culturomics doubles the number of species isolated at least once from the human gut.

Noncontiguous finished genome sequence and description of Enterococcus massiliensis sp. nov

Enterococcus massiliensis strain sp. nov. (= CSUR P1927 = DSM 100308) is a new species within the genus Enterococcus. This strain was first isolated from a fresh stool sample of a man during culturomics study of intestinal microflora. Enterococcus massiliensis is a Gram-positive cocci, facultative anaerobic and motile. E. massiliensis is negative for mannitol and positive for β-galactosidase, contrary to E. gallinarum. The complete genome sequence is 2 712 841 bp in length with a GC content of 39.6% and contains 2617 protein-coding genes and 70 RNA genes, including nine rRNA genes.

[Heller myotomy by transthoracic procedure, a single center experience in Mali with 21 cases]

AIMS

To evaluate the midterm results of myotomy for achalasia by thoracotomy procedure with the introduction of anti-reflux system by diaphragmatic flap.

PATIENTS AND METHODS

This was a prospective study involved 21 patients (14 women and 7 men) operated for idiopathic megaesophagus during a period of 3 years. All the patients were operated by thoracotomy procedure. An anti-reflux system was performed using a diaphragmatic flap over the entire length of the myotomy.

RESULTS

The mean age was 32 years (range 16 and 68 years). After the surgery we have seen a complete disappearance of dysphagia in 21 patients (100 %) (p <0.001) and a significant weight regain. Short term outcomes were marked by the occurrence of clinical gastroesophageal reflux disease in 1 patient (4.76%) who has received the anti-reflux system (p> 0.05).

CONCLUSION

Oeso-cardio-myotomy of Heller by transthoracic procedure associated with the establishment of an anti reflux system by diaphragmatic flap has goods results.

[Complications of digestive ostomies in pediatric surgery]

AIMS

To determine the frequency and factors of complications of intestinal stomas.

METHODS

This was a retrospective study over a 7 year period from January 2004 to December 2010, covering all children aged 0-15 years, who received a stoma and hospitalized in the period of study. Excluded from this study, alimentary ostomy and urological ostomy, and children whose medical records were incomplete.

RESULTS

We examined 192 cases of stoma or 27 cases/year. We noted a complication in 91 (48%) of our patients. The average age was 3.64 ± 5.03 years ranging from 6 hours and 15 years. The complicating factors were: the indication for surgery, type of stoma, the variety of stoma, surgical technique and equipment.

CONCLUSION

The achievement of good technique and appropriate equipment would be needed to reduce some complications of the stoma.

[Amoebic liver abscess in general surgery at the Gabriel Touré teaching hospital, Bamako, Mali]

The objectives were to determine the frequency, and to describe the clinical and therapeutic aspects of amoebic liver abscess. This was a retrospective study in the general surgery department of the Gabriel Touré teaching hospital from 1 January 2004 to December 2008. Included in this study, were all patients hospitalized and treated for amoebic liver abscess. We collected 53 cases a frequency of 1.3%. This was 45 men (84.9%) and 8 women (15.1%). The sex ratio was 5.6. The average age was 39.5 years. The average consultation time was 3 weeks. The signs observed were fever 96.2% (51 cases), the hepatalgia 94.3% (50 case), hepatomegaly 90.6% (48 cases) and anorexia 88.7% (47 cases). Collections of objectified abscess in abdominal ultrasound were located in the right lobe in 79.2% (42 cases), unique in 92.5% (49 cases) and 100 mm in diameter on average. Pulmonary radiography found an elevation of the right diaphragmatic dome 66.7% (14 cases). Amoebic serology was performed in 60.4% of cases, was negative in 2 cases (6.2%). Medical treatment alone was effective in the majority of cases - 62.7% (32 cases), an ultrasound-guided paracentesis associated with medical treatment was required in 31.4% (16 cases). Surgical methods were very rarely recommended 5.9 % (3 cases). The average amount of pus was 637.6ml. Average duration of treatment was 11 days. We recorded three deaths, including one due to a sepsis on peritonitis from ruptured liver abscess and 2 cases due to HIV.

CONCLUSION

The amoebic liver abscess is uncommon in our service. Negative serology does not exclude the diagnosis. Medical treatment is usually curative in the absence of complications.

[Necrotic ulcer in a general surgery department at Gabriel Tour Hospital]

Our objectives were to determine the frequency, clinical, and therapeutic aspects and to evaluate the cost of care.

PATIENTS AND METHOD

This was a retrospective, analytical study, , carried out in the general surgery department of the teaching hospital Gabriel Touré from 1 January 2000 to December 2008. Were included in this study all patients operated for necrotic ulcer in the service.

RESULTS

Seventy -nine (79) patients were identified which represents 0.6 % of our admissions. There were 48 men (60.8%) and 31 women (39.2%) . The sex ratio was 1.5 . The average age was 33.6 years, with extremes ranging from 31-81 years and the standard deviation = 19.7. The diagnosis was based on clinical and paraclinical investigations in all patients (100 %). The average period of consultation was 1.2 months, with extremes ranging from 1 - 24 months and the standard deviation = 0.8. Traditional medications were given to 38 patients (48.1%). The ulcer was multiple in 20 patients (25.3%). In 57 cases (72.2%) it sat in the lower limb and in 22 cases (27.8 %) in the upper limb. The average diameter was 24.3 cm and the standard deviation = 15.1. Trauma and infection were, respectively, the main causes in 63 patients (79.7 %) and 10 patients (12.6%). The most frequent germs found were the Staphylococcus aureus in 40 patients (50.6%) and Proteus mirabilis in 10 patients (12.7%). The thin skin autograft was performed in 66 patients (83.5 %). Healing was complete in 52 patients (78.8%), with a morbidity of 21.2 % (14 cases) . Infection was observed on graft and edema, 5 cases each (7.6%), graft rejection 4 cases (6.1%). The average hospital stay was 2.3 months. The average cost was 237,450 with a range of 75,000 to 500,000 FCFA.

CONCLUSIONS

Necrotic ulcer is an uncommon pathology in our department. The lack of consultation and the use of traditional medication are the main factors of seriousness.

[Tracheal intubation in the Emergency Unit: accidents and incidents in the teaching hospital of Gabriel Touré of Bamako]

INTRODUCTION

Intubation in urgency is characterized by a greater difficulty compared with intubation in situation regulated with the operating theatre suite. In urgency, the determination of the predictive anatomical factors of difficult intubation is secondary. The incidence of the complications of endotracheal intubations in urgency in the French system was 11,6% with a rate of failure to 0,5.

OBJECTIVE

To study the incidents and accidents during endotracheal intubations in the service of reception of the urgencies with the Gabriel TOURE teaching hospital of Bamako.

PATIENTS AND METHOD

A prospective cross-sectional study was conducted from October 2010 at September 2011 with the service of reception of the urgencies of the Gabriel Touré teaching hospital. All the intubated patients were included. All the patients received a clinical evaluation and paraclinic examinations. Clinical monitoring was carried out in the 24 hours following the accident. The statistical test which was used for the comparison of our results was Khi ² with a threshold of significance fixed at P<0,05.

RESULTS

For the period of study 120 cases of accidents and incidents were collected for 320 intubated patients - a frequency of 37,5%. The age bracket 15 - 29 was prevalent representing 30,8 % of patients. The sex ratio was 2,3 in favour of men. In 44.3% of cases patients died in the 24 hours following intervention. Only patients admitted for cranial traumatism presented undesirable side effects in 50% of the cases versus 50% for the other joined reasons for admission.

CONCLUSION

The accidents during endotracheal intubation in urgent interventions are considerable, hence the acquisition of more suitable material and good training would decrease incidence.

[Typhoid peritonitis in children: Evaluation of morbi-mortality at the Gabriel Touré teaching hospital in Bamako]

AIMS

To determine related factors of complications typhoid perforations in the small intestine in children.

MATERIAL AND METHOD

A retrospective study was conducted between June 1^st, 2005 to June 30^th, 2010 in all children aged 0 to 14 years treated for peritonitis by ileal perforations in the service of paediatric surgery at the Gabriel Touré teaching hospital. Traumatic perforations and patients with incomplete files were not included in this study.

RESULTS

In 5 years time we gathered 105 cases of ileal typhoid perforation. After surgical treatment early outcomes were simple in 70 patients (66.6%), a parietal suppuration had been noted in 15 patients (14.3%) and fistula in 4 (3.9%). Sixteen patients (15.2%) died. Complications were related to patient's age, ASA Score, time frame of care, quantity of peritoneal fluid, number and site of perforation, surgical techniques and the duration of surgery P(<0.05). Sex, anaemia, surgeon, and perforation diameter did not significantly influence the rate of complications.

CONCLUSION

Reduction of morbi-mortality happens through prevention, earlier diagnosis and appropriate management of typhoid fever.

[Intestinal invagination occurring during pregnancy: 1 case]

Acute intestinal invagination is a rare pathology in adults; even more so on specific fields as in pregnant women. Therapeutic indications depend on the duration of the invagination. We noted a cases of acute intestinal invagination after 72 hours of evolution in a multiparous 35 year old woman, 27 weeks pregnant, successfully treated by surgery and tocolysis.

[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.

[Peritonitis by perforation on gastric cancer at the Gabriel Touré teaching hospital]

OBJECTIVE

Describe the therapeutic and diagnostic aspects of gastric cancer perforations at the general surgery department of the Gabriel Touré teaching hospital.

PATIENTS AND METHOD

A retrospective survey was conducted over 11 years (January 1999 to December 2010). It included all patients having had surgery for peritonitis by gastric cancer perforation at the service during that time frame.

RESULTS

We found 14 cases of peritonitis due to gastric perforation, of which 9 were male and 5 female. The main clinical symptoms were abdominal pain (100%), weight loss (100%) and abdominal contraction (98.8%). Endoscopy allowed to note a pyloric antrum budding tumor in 4 patients before perforation. Radiography of the abdomen without preparation showed pneumoperitoneum in 8 cases. In all cases, the histological type recorded was adenocarcinoma. The antral seat was the most common (64.3%). Palliative surgery was immediately performed in all cases. We recorded two cases of fistula tract and 3 cases of infection of the lining, as well as 2 cases of postoperative mortality.

CONCLUSION

Gastric cancer perforation is rare and of bad prognosis as it survives on advanced cancer.

[Penetrating abdominal wounds caused by weapons in the service of general surgery in the Gabriel Touré teaching hospital]

INTRODUCTION

Providing care for penetrating abdominal wounds is a controversial subject. The aim of this project was to describe their epidemiological, clinical and therapeutic aspects.

MATERIALS AND METHODS

This retrospective study conducted over 4 years, from January 2006 to January 2010 concerned 70 cases of penetrating abdominal injury in the general surgery department of the Gabriel TOURE teaching hospital. Non-piercing and animal horn related abdominal injuries were not included.

RESULTS

We collated 70 cases of penetrating abdominal wounds; representing 1.2% of hospitalisations during the studied time frame. The patients were 12 to 59 years old with a mean age of 27.7 years and a sex-ratio of 9 to 1 for men. 27 patients (38.36%) came from districts I and II of Bamako. Criminal injuries was the main cause of injury encountered representing 70% cases. 3 of the patients had psychiatric antecedents and 45.7% of patients regularly consumed drugs. The epiploon and small intestine were the main eviscerated organs (51.4% cases). 17/53 patients received non-surgical treatment. The rate of laparotomia was of 30.2% and postoperative morbidity 15.1%.

CONCLUSION

Treating penetrating abdominal injury remains difficult. A good selection of patients allow the service to lower the rate of laparotomia.

Repeated artemisinin-based combination therapies in a malaria hyperendemic area of Mali: efficacy, safety, and public health impact

Artemisinin-based combination therapies (ACTs) are the first-line treatment of uncomplicated malaria. The public health benefit and safety of repeated administration of a given ACT are poorly studied. We conducted a randomized trial comparing artemether-lumefantrine, artesunate plus amodiaquine (AS+AQ) and artesunate plus sulfadoxine-pyrimethamine (AS+SP) in patients 6 months of age and older with uncomplicated malaria in Mali from July 2005 to July 2007. The patient received the same initial treatment of each subsequent uncomplicated malaria episode except for treatment failures where quinine was used. Overall, 780 patients were included. Patients in the AS+AQ and AS+SP arms had significantly less risk of having malaria episodes; risk ratio (RR) = 0.84 (P = 0.002) and RR = 0.80 (P = 0.001), respectively. The treatment efficacy was similar and above 95% in all arms. Although all drugs were highly efficacious and well tolerated, AS+AQ and AS+SP were associated with less episodes of malaria.

[Comparaison between the association of chlorhydrate ketamin-magnesium sulfate ketamin chlorhydrate and in paracetamol aving in visceral surgery]

AIM

To compare paracetamol saving followed by the association of ketamine chlorhydrate - magnesium sulfate to ketamine chlorhydrate and analyze cost after the 2 protocols administration.

MATERIAL AND METHODS

We conducted this comparative study from June 2005 to January 2006 in the services of anesthesiology and resuscitation and visceral surgery of the teaching hospital Gabriel Touré, Bamako. 80 patients were split into 2 groups - group A receiving: 0,25mg/kg of ketamine chlorhydrate plus 50mg /kg of magnesium sulfate, group B receiving: 0,25mg/kg of ketamine chlorhydrate.

RESULTS

The 2 groups were compared by anthropometrical and clinical data (age, sex, weight) and ASA. The reduction of paracetamol dosage was 57, 50 % of the 4 g actually used per day in A group against 48, 50% in B group.

CONCLUSION

Ketamin chlorhydrate associated to magnesium sulfate insure a post-operative analgesic saving in visceral surgery. Cost of analgesia actually used is reduced.

[Non-resecable gastric cancers at the department of general surgery at CHU Gabriel TOURE Bamako]

Our objectives were to determine the frequency of non-resecable gastric cancers, to analyse its clinical, and therapeutic aspects, and to assess patients follow-up.

METHOD

Our retrospective study has been from 1st January 2008 to 31st December 2009. It included all patients operated or not having non-resecable gastric cancers at general surgery at CHU Gabriel TOURE

RESULTS

We have recorded 305 cases of advanced gastric cancers, accounting for 71.4% of gastric cancers (n=425), 47.8% of digestive cancers (n=766) and 2.2% of hospitalisations. The sex ratio was 1.6 in men favour; the average age was 57 } 12 with extremes of 25 and 90. The average evolution delay was 15.5 months with extremes of 5 and 7, and standard deviation 19.2. 14 patients have been admitted in an emergency context. (8 cases of gastric perforation related peritonitis, 6 cases d’haematemesis). The main found signs were: epigastric tumours 187 (61.3%) cases, lower limbs oedema 105 (34.4%) cases, ascitis 105(34.4%) cases, hepatomegaly 68(22.3%), lymphadenopathy ≪ ganglions de Troisier ≫21(7%), ≪ ecailles de Brumer ≫ (= Brumer’s scales) from rectal touch 17(6%) cases More than half of patients have been classified ASA 4.105(34.4%) ASA 5, and 74(24.2%) ASA . The tumour location was antrum in 260(85.2%) cases Cardiac orifice in 17(5.5%) cases, fundus i n 11(3.6%), the gastric linitis in 17(5,5%) cases. The imaging has found the ascitis in 119(39%) cases, the hepatic metastases in 54(17.7%) cases, pulmonary in 36(19%) cases, pancreatic 5(1.6%) cases, splenic in 4(1.3%), and ovarian in 3(1%) cases 105(34.4%) patients had no surgery, 4(1.3%) had chemotherapy, and 200(65 %) had surgery. The mortality rate was at 16.5% and the one year survival at 15.5%.