[Spermiological Study Of Patients Treated For Infertility At The Medical Biology Laboratory Of Sikasso Hospital]

AIM

The aim of this study was to establish the spermiological profile of patients treated for infertility at Sikasso Hospital.

MATERIAL AND METHODS

This was a prospective descriptive cross-sectional study, which took place from January to December 2022 at Sikasso Hospital. Interpretation of spermiological parameters was based on standards established by the World Health Organization in 2010.

RESULTS

We enrolled 41 patients, 51.22% of whom had disturbed spermiological parameters. The abnormalities were azoospermia (21.92%), asthenooligozoospermia (12.20%), asthenozoospermia (7.32%), oligozoospermia (7.32%) and asthenonecrozoospermia (2.44%). These anomalies were mainly observed in the 34-44 age group (47.62%).

CONCLUSION

This study revealed significant disturbances in spermiological parameters, with azoospermia being the most frequent abnormality.

An examination of mercury levels in the coastal environment and fish of Cote d'Ivoire

Artisanal and small-scale gold mining (ASGM), energy production and other industrial inputs are a major source of anthropogenic mercury (Hg) to the aquatic environment globally, and these inputs have led to environmental contamination and human exposure. While studies have documented the effects of Hg inputs to rivers and marine waters of the West African region, estuarine waters of Cote d'Ivoire have been understudied, besides the waters surrounding Abidjan. To fill this gap, and to examine the potential for human exposure to methylmercury (MeHg), we measured the concentrations of total Hg, MeHg, and ancillary parameters in water (dissolved and particulate phases), sediment and fish to determine the extent of environmental impact and the potential for MeHg exposure for people consuming these fish. Levels of Hg and MeHg in sediment were elevated in the vicinity of the urban environment (up to 0.3 ng/g dry weight (dw) MeHg and 623 ng/g dw total Hg) and lowest in the more remote estuarine environments. Measurements of Hg in tuna and other larger pelagic coastal species indicated that levels were elevated but comparable to other North Atlantic regions. However, levels of Hg in fish, even smaller estuarine species, were such that the rural and urban populations are potentially being exposed to unsafe levels of MeHg, primarily as a result of the relatively high fish consumption in Cote d'Ivoire compared to other countries. Overall, both local point sources and the transport of Hg used in interior ASGM activities are the sources for Hg contamination to these coastal waters.

[Risk factors and management of uterine rupture in a 1st reference structure in Mali: case of the Bougouni health district]

The objective was to assess the risk factors for and to suggest therapeutic aspects.

MATERIALS AND METHODS

We carried out a case-control study at the Bougouni Reference health center in 2019.

RESULTS

From January to December 31, 2019; out of 1161 deliveries, 43 uterine rupture were recorded, 3.7% corresponding to one uterine rupture for 27 deliveries. Patients 35 years and older were more affected by uterine rupture (44.2%) with ORaIC95% = 6.3 [1.5 - 26.3]. Obstetric evacuations had an ORaIC95% = 25.6 [7.8-83.7]. All of the patients were housewives (97.7%) versus (82.3%) controls with ORaIC95% = 8.9 (1.1-69). Pauciparous and multiparous had an ORaIC95% = 6.2 [1.8 - 20.3] and 4.1 [1.3 - 12.9], respectively. The uterine scar (20.9%) of cases versus 8.1% of controls had a 95% ORaIC95% = 2.9 [1.1 - 8.7]. Indeed the absence of ANC was a risk factor, ORaIC95% = 3.0 [1.3 - 6.9]. The time to uterine rupture was < 6 hours in 95%. In fact 34 complete uterine rupture (79.1%) and 9 incomplete uterine rupture (20.9) were noted. Only 2.3% of cases gave birth vaginally. Treatment of uterine rupture was based on surgery (100%) supplemented by shock (51.2%) of cases and infection (100%) of cases.

CONCLUSION

Uterine rupture is common in our countries under medical care. Its effective prevention involves strategies aimed at acting on risk factors.

[COVID 19 in intensive care: epidemiological, clinical and prognostic aspects in Bamako]

OBJECTIVE

to report the epidemiological, clinical, paraclinical and therapeutic characteristics of the first COVID 19 patients in intensive care.

PATIENTS AND METHOD

retrospective descriptive and analyticalstudy over 4 months, covering all adult patients tested positive for SARS-Cov-2 and admitted to intensive care.

RESULTS

49 patients, 35 men and 14 women (2% of cases) were admitted to intensive care. The median age was 64 years [26 - 92]. Hypertension (16; 32.6%), and diabetes (11; 22.4%) were the mostcommoncomorbidities. The most common symptoms on admission were cough (38; 80.9%), shortness of breath (35; 74.5%), and fever (33; 70.2%). The median time to onset of symptoms was 11 days. Non-invasive ventilation (NIV) was used in 21 patients (42.9%). Fourteen (28.6%) wereintubated and put onassisted ventilation. The mean hospital stay was 7.77 ± 7.30 days. We recorded 20 (40.8%) deaths. Factors associated with death were high blood pressure, onset of shock, and on mechanical ventilation.

CONCLUSION

Covid-19 remains a public healthproblemwith high morbidity and mortality. The morbidity and mortalityfactorsare: comorbidities and the severity of the clinicalpicture.

[Epidemiological and prognostic aspects of obstructive renal deficiency in the nephrology department of the Point "G" hospital, Bamako, Mali]

INTRODUCTION

Obstructive renal failure or obstructive uropathy is an entity defined by the simultaneous presence of impaired renal function and dilated urinary excretory pathways in medical imaging. It accounts for 2 to 10% of the causes of acute renal failure (ARF). The purpose of this work was to evaluate the prevalence of this condition in our department.

METHOD

This was a retrospective study conducted from January 1, 2017 to June 30, 2018 in the said department. The parameters studied were age, sex, etiology, type of renal failure, actions performed, surgical results of the procedure, creatinine level before and after management, and death rate.

RESULTS

obstructive renal failure accounted for 7.32% of all hospitalizations during the study period. The sex ratio was 1.86 in favor of men. The average age was 48.99 ± 6.81 years with extremes of 7 and 102 years. The etiologies were dominated by lithiasis (43.4%). Renal failure was acute and chronic in 20.5% and 54.2% of cases, respectively. It was indeterminate in 25.3% of cases. The obstructive character of renal failure has been confirmed in medical imaging. Lithiases accounted for 43.4% of cases. For therapeutic management, our patients received urinary catheterization (38.6%), nephrostomy (34.9%), urological surgery (22.9%) and hemodialysis (22%). The evolution was favorable in 59% of the cases.

CONCLUSION

Obstructions of the upper urinary tract are becoming more frequent in our medical practice. They occur mainly in patients with lithiasis. There is a large proportion of kidney failure requiring hemodialysis.

[Prevalence of the kidney disease at the emergency department of hospital Fousseyni Daou of Kayes]

INTRODUCTION

Kidney disease (KD) is defined as a set of functional, morphological and histological kidney abnormalities. It is a truly global public health problem. Its prevalence is estimated to be 50 times that of end-stage renal disease (ESRD). In Kayes, there is no data on the prevalence of kidney disease, hence the interest of this study.

OBJECTIVES

to determine the prevalence of renal disease, its main causes and the main factors of aggravation of this pathology in the emergency department at hospital Fousseyni DAOU of Kayes.

METHODOLOGY

Retrospective cross-sectional study carried out from January 1, 2014 to February 1, 2015. We included all hospitalized patients in whom a renal damage marker (elevation of plasma creatinine, urinary sediment abnormality, ultrasound, histology and significant proteinuria) has been found.

RESULTS

the prevalence of kidney disease was 9.9% (109/1099). Eighty-nine met the inclusion criteria. The study population was composed of 47 women (52.8%) and 42 men (47.2%), with a sex ratio of 0.89 in favor of women. The average age was 40.09 years with a predominance of patients in the age group [40-59]. The main reasons for consultation were hypercreatininaemia (48.3%), edematous syndrome (16.9%), low back pain (10.1%). High blood pressure (55.1%) and lower extremity edema (46.1%) were the medical history frequently found in our study. The kidney disease found was in order of growth: chronic renal failure (51%); acute renal failure (28%); proteinuria (16%), hematuria (3%), morphological abnormality of the kidneys (2%). Tubulointerstitial nephropathy represented 64% of acute renal failure with P = 0.000306. Vascular nephropathy constituted 46.7% of chronic renal failure with P = 0.000251. No cases of glomerular nephropathy were found in patients over 60 years of age.The most common causes were represented by nephrotoxic drugs injuries; infectious; high blood pressure and diabetes. The most observed aggravating factors are herbal medicine, urinary tract infections, renal hypoperfusion and unbalanced hypertension.

CONCLUSION

kidney disease is not uncommon in the emergency room at Hospital Fousseyni Daou of Kayes. The most common causes are nephrotoxic drugs, hypertension and diabetes.

[Contribution of the University Clinical Research Center's laboratoryin the diagnosis of SARS-CoV-2 in Mali]

INTRODUCTION

The rapid diagnostic capacities of laboratories in Mali have been an essential element in the response to COVID-19. The University Clinical Research center (UCRC) diagnosed the first cases of Mali COVID-19.

OBJECTIVE

The objective was to describe the contribution of the UCRC in the diagnosis of Covid-19 and to clinically and epidemiologically characterize the patients tested in the UCRC laboratory.

MATERIALS AND METHODS

A cross-sectional study was conducted during eight months of intense activity. The samples were sent from the National Institute of Public Health (INSP) to the UCRC.

RESULTS

The UCRC tested 12,406 contacts and suspected samples and confirmed the diagnosis in 1091 patients, or 9%. The most common symptoms were cough (48.78%), headache (34.14%), fatigue / weakness (34.14%), while (33.33%) of the patients were asymptomatic. The sample positivity rate among new cases decreased from May to September 2020, despite almost 230% of the number of samples tested.

CONCLUSION

The laboratory played a major role in the response and there may be a low transmission of the virus in the Malian community.

[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.

[Acute renal failure due to covid-19: about the two cases in Mali]

The kidney is one of the target of Covid-19. Damage may present itself as acute renal failure (5-35% of patients), hematuria (30-40%) and/or proteinuria (40-65%). We report the first couple cases of acute renal failure due to Covid-19 in Mali : a 63years old woman and a 60years old man, both black and diabetics. The circumstances of discovery of renal failure were oliguria in both cases and total macroscopic hematuria for the man.

CONCLUSION

The kidney damages become more and more frequent during Covid-19 infection. We suggest that they should be systematically investigated as soon as the diagnosis of this infection is made.

[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.

[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.

[Surgical site infections at surgery service B of Point "G" hospital]

BACKGROUND

Surgical site infections (SSI) complicate most operations in developing countries. A variety of germs is responsible for it. The purpose of this study was to determine the incidence of surgical site infections and the bacteriological profile.

PATIENTS AND METHODS

We conducted a prospective study for descriptive purposes. The included patients were treated between August 2016 and July 2017 in the Surgery B department of the University Hospital Center Point G. The study population consisted of all patients operated on and hospitalized for at least 72 hours. Patients who had an infection of the operative site were retained. The incidence of ISOs, the different bacterial strains and their susceptibility to antibiotics were studied. Data was analyzed on SPSS 12.0.

RESULTS

The incidence of surgical site infections was 4.7%. The median age of the patients was 29.5 ± 4.34, the sex ratio was 1.66. The average time to onset of infections was 7.33 days. Of the samples taken, 4 bacterial strains were identified: Escherichia coli, Staphylococcus aureus, Acinobacter baumanii and Enterobacter spp. Isolated strains of Escherichia coli and Staphylococcus aureus were sensitive to Cefotaxim, Amikacin, Nitrofurantoin, but resistant to Ceftriaxon, Amoxicillin + Clavulanic acid. The species of Acinobacter baumanii and Enterococcus spp. Were sensitive to Colistin, but resistant to Ceftriaxone, Amoxicillin + clavulanic acid.

CONCLUSION

Escherichia coli and Staphylococcus aureus are the main germs of the generally antibiotic-resistant ISOs commonly used in the service.

[Mortality in the hemodialysis unit of the Gavardo hospital in sebenikoro]

INTRODUCTION

Chronic kidney disease (CKD)is a serious public health problem in Africa with regard to mortality associated with it. According to global hospital data, CKD is involved in 4-22% of deaths in tropical Africa. In Mali, epidemiological studies are infrequent.Thus, this work is under taken with the objective of studying the epidemiological aspects and the factors associated with the mortality of hemodialysis patients in the hemodialysis unit of the Mali Gavardo Hospital (HMG) in Sébenikoro.

METHOD

We conducted a descriptive retrospective cross-sectionalstudy of the hemodialysis unit of the HMG in Sébenikoro. Data were collected over a 12-month period from January to December 2017. Included were records of all hemodialysis patients for chronic renal failure who died, of either sex and anyage.

RESULTS

A total of 52 patients were dialysed during the study period among whom 12 died or a mortality rate of 23%. The average age of the patients was 59.16 years with extremes of 39 and 71 years. Patients aged 60 and over accounted for 58.3% of cases. There was a male predominance with a sex ratio M / F: 2. In terms of chronic diseases, 83.3% of patients were hypertensive, 50% diabetic, and 16.66% hadhepatitis C. Compared to the initial nephropathies : glomerular nephropathy: 58.3%, vascular nephropathy: 25.0%, undetermined nephropathy: 16.7%. For the management of anemia, 100% ofour patients received EPO and iron injection. Regarding the management of hemodialysis, 83.3% had an AVF as a vascular approach and 16.7% had a central venous catheter as a vascular approach. The patients were all regular at their hemodialysis session with a rhythm of two sessions of 04H of time per session and per week. The causes of death were dominated by cardiovascular pathologies: 5 cases, 41.7%, infectious diseases: 4 cases, 33.3%, indeterminate pathologies: 3 cases or 25%. Deaths occurred in 58.3% of cases before one year of dialysis and 41.7% after one year of hemodialysis treatment.

CONCLUSION

The mortality rate of hemodialysis patients is high in Mali, especially in the HMG of Sébénikoro. Cardiovascular causes have an important role in the mortality of hemodialysis patients, but other causes such as infections are not to be over looked.

[Spontaneous acute subdural hematoma of the chronic hemodialysis patient, a case study and review of the literature]

INTRODUCTION

The appearance of spontaneous subdural hematoma (SSDH) is a rare phenomenon in chronic hemodialysis and is burdened with significant morbidity and mortality. It's prevalence remains low in Sub-Saharan Africa, is 0.43%. We report a case of SSDH in a young hemodialysis patient with favorable outcome after medico-surgical management.

CLINICAL OBSERVATION

This is a 35-year-old patient who has been hemodialysed since June 2016 for chronic renal insufficiency of hypertensive origin. He was admitted on 18 July 2018 in the nephrology department of CHU Point G for intense headaches in a context of dysarthria. They associate themselves with speech disorders, photo-phonophobia, uncontrollable nausea and vomiting. It does not report any notion of head trauma. The physical examination noted dysarthria, a right pyramidal syndrome made of right Babinsky sign, right arm deficit at 4/5, and right hemicorporeal hyperkinesia. He weighed 62 kg for 165 cm, the blood pressure was 187 / 110 mmHg. The patient had clinical signs of extracellular dehydration. Non-injected cerebral CT showed an acute left sub-dural hematoma with peri-lesional cerebral hypodensity. Surgical evacuation of the hematoma through a trephine hole is performed under local anesthesia. The postoperative course was simple. His hemodialysis sessions were done without heparin from diagnosis until 23 days post operatively.

CONCLUSION

Spontaneous subdural hematoma is multifactorial and rare in the dialysis patient. Despite high morbidity and mortality, hemodialysis should not refute surgical management of subdural hematoma.

[Fracture of the penis at teaching university hospital Luxemburg in Mali : two cases report]

The fracture of the penis is a rare andrological emergency. We report 2 cases of fracture of the penis including one by false-no coitus. These were young adults aged 34 and 40 respectively. The painful swelling with deviation of the penis was the dominant symptomatology of the clinical picture of the 2 patients. Surgical management was performed with favorable functional results in both cases. The long-term functional prognosis of the fracture of the penis depends on the speed of its management.

[Diagnosis and treatment of acute surgical abdomen in Koutiala]

PURPOSE

To describe the epidemiological, clinical and therapeutic aspects of acute surgical abdomens at the Koutiala Reference Health Center.

PATIENTS AND METHOD

This was a prospective and descriptive study from August 1, 2017 to May 31, 2018. It included all patients operated on for acute abdomen in the General Surgery Department of the Koutiala Reference Health Center. The study did not include the nonoperated surgical acute abdomens, the non-surgical acute abdomens. Clavien-Dindo classification was used to evaluate complications.

RESULTS

One hundred patients were registered. Acute surgical abdomens accounted for 8.4% of consultations (n = 1190), 27.7% of surgical procedures (n = 361) and 70% of surgical emergencies (n = 142). The average age was 34.4 years ± 18.5. Men were in the majority with 70%. The mean duration of change in symptomatology was 4.8 days ± 5.4. Patients consulted for abdominal pain (100%), fever (60%), vomiting (88%) and discontinuation of materials and gases (32%). The physical examination noted abdominal distension (53%), abdominal contracture (36%), abdominal defense (56%) and pain in the cul de sac of Douglas (95%). X-rays of the abdomen without preparation and abdominopelvic ultrasonography contributed to the diagnosis in 46% of cases and 18% of cases, respectively. Acute appendicitis (35%) was the most common etiology followed by acute peritonitis (31%) and acute intestinal obstruction (15%). We performed an appendectomy in 45 patients (45%), resection anastomosis (15%) and excision-suture (13%). The average duration of hospitalization was 4.7 days. The morbidity was 12%. According to the Clavien-Dindo classification, 9 patients were grade III and 3 grade V. The mortality was 3%.

CONCLUSION

Acute surgical abdomens are the most common emergencies in our practice. The diagnosis is clinical and para-clinical most often. Morbidity and mortality remain elevated. The outcome of treatment depends on early management and mastery of abdominal surgery techniques.

[Surgical disorders during pre-trial detention at camp 1 of gendarmerie, Bamako (mali): medico-legals aspects]

The aim of this work was to describe the epidemiological and therapeutic aspects of surgical diseases in patients in pre-trial detention at Camp 1 of Gendarmerie in Bamako (Mali) and to evaluate the medico-legal aspects of this management.

METHOD

It was a descriptive retrospective study over a three year period (January 2014 to December 2016). Included were all detainees who had stayed at the Bamako Gendarmerie Camp 1 detention center and whose medical care had required a surgical procedure, performed or coordinated by the staff of the garrison.

RESULTS

Clinical records of 42 inmates-patients were collected. Their average age was 36.5 years varying between 24 years and 73 years and all of them were men. The average length of pre-trial detention was 17 months varying from 16 days to 39 months. On arrival, 35.7% of the detainees (15/42) benefited from an initial examination by a garrison infirmary health worker. Among them, 46.7% (7/15) required urgent surgical procedures. The average time to access care was 4 hours varying from to 6 days. Consent to care was obtained from 54.8% (23/42) of prisoners prior to any medical procedure. Traumatic conditions were the main etiologies of emergency care. Systematic screening for communicable diseases and exit visit at discharge were not performed. Over the 3 yearlong study period, no case of death was recorded.

CONCLUSION

The medical and surgical management of these detainees has enabled the staff of the garrison infirmary at Camp 1 to acquire knowledge and skills in detention health. The impact of this acquisition is reflected as an improvement in the quality of care over the years.

[Acute Complications Of Snakebite Envenomation In Department Resuscitation Of CHU-Mother Child "Luxembourg" Of Bamako]

Envenomation by snakebite remains a public health problem in Africa. The purpose of our work was to study the acute complications of snakebite envenomation and the risk factors for its complications.

METHOD

This was a retrospective and prospective study over a period of 07 years, which was performed in the department of anesthesia resuscitation and emergencies of CHU-Mother Child "Luxembourg" of Bamako.

RESULTS

During this period, 76 cases of Ophidian envenomation were recorded. The average age of the patients was 34 ± 12 years old. . The family of vipers (Echis and Bitis) was the most incriminated 84,61% of the cases. Hemorrhagic complications were observed in 78.94% of patients, other complications (cardiovascular, neurological, dermatological, ophthalmological ...) were observed in 21.05% of patients. The main risk factor for complication observed was the delay in management (> 6 hours delay) in 100% of patients. The absence of serotherapy and or the initial resort to traditional treatment have been complicating risk factors. Almost all victims of Elapidae bites, 89.9% (5/6 cases) died. Serotherapy was performed urgently in 97.4% of cases. The morbidity in our study was 10.52% with a 7.8% mortality.

CONCLUSION

in our context, the management of envenomations by snake bite remains dependent on a multitude of complications. The prognosis is conditioned by the early administration of symptomatic treatment and a specific antidote.

[Non-traumatic digestive perforation in Koutiala: epidemiological and therapeutic aspects]

PURPOSE

the aim of this study was to evaluate the clinical and therapeutic aspects of non-traumatic digestive perforations at the Koutiala Reference Health Center.

PATIENTS AND METHODS

This was a prospective and descriptive study from August 1, 2017 to December 31, 2018. Patients admitted and operated on for non-traumatic digestive perforation were included. The parameters studied were age, sex, frequency, clinical aspects, etiologies, treatment and operative follow-up.

RESULT

Sixty-one patients were registered. Non-traumatic digestive perforations accounted for 78.2% of cases of acute peritonitis (n = 78). Men were in the majority with 73.8%. The average age was 34.5 years old. The symptomatology was represented by abdominal pain in all patients, vomiting in 56 patients and fever in 42 patients. The mean duration of evolution of the symptomatology was 5.5 days. On physical examination, the most common signs were abdominal contracture with 81.9%, disappearance of prehepatic maturation (52.4%) and pain in rectal examination (95.1%). Radiological pneumoperitoneum was found in 39 patients. The serodiagnosis of Widal was positive in 15 cases. The etiologies were dominated by perforation of infectious origin with 77.0% (46). The perforation was ileal in 28 patients, appendicular in 18 patients and gastroduodenal in 11 patients. Excision-suturing of the perforation was done in 30 patients, resection anastomosis in 8 patients and appendectomy in 18 patients. Morbidity and mortality were respectively 14.7% and 6.5%.

CONCLUSION

Non-traumatic digestive perforations are the first cause of peritonitis in our department. The ileal seat is the most common and is most often secondary to typhoid fever. Morbidity and mortality remain high and this result is a reflection of late diagnosis which is the main factor of severity of digestive perforations.

[Pregnancy In Chronic Hemodialysis, Case Study]

For a long time, pregnancy in chronic hemodialysis was considered medically contraindicated, because of the many maternal complications that it could cause. Its management is as heavy for the medical teams (nephrologist, obstetrician and neonatologist) as for the patient herself. We report here a case of pregnancy in a dialysis patient observed at the Madeleine clinic in Dakar, Senegal. This pregnancy is the first described with a birth of a living child having a normal birth weight without abnormal malformative thanks to the multidisciplinary follow-up nephrologist, obstetrician and neonatologist), the intensification of dialysis care, the correction of anemia, control of blood pressure and improvement of the mother status nutritional.

Success rate of first attempt 4% articaine para-apical anesthesia for the extraction of mandibular wisdom teeth

Dental extraction is one of the acts that cannot be undertaken or carried out without total analgesia. Unfortunately, the success of anesthesia is not always systematic. Failures are noted during the extraction of mandibular wisdom teeth and pain management therefore remains a challenge for their extraction. The anesthesia technique and nature of the adapted anesthetic solution are controversial. However, the most commonly used technique is the Lower Alveolar Nerve Block (IANB). This technique has disadvantages (trismus, risk of intra-arterial injection and hematoma) and a failure rate of up to 88%. In some survey, 90% of 93 practitioners had difficulty obtaining proper anesthesia. Other clinical studies have also shown overall failure rates of 37%-47%, and 15%-35% on healthy lower molars. Recent studies have evaluated the success rate of articaine at between 54% and 94%, while others have shown that for mandibular teeth, articaine is more effective in para-apical anesthesia than lidocaine. Sixty subjects were selected for the study. The aim was to evaluate the overall success rate of first intention 4% articaine para-apical anesthesia during extraction of third mandibular molars. The overall success rate of para-apical anesthesia was 87%.

[Prevalent Of Echocardiography Anomaly In Chronic Hemodialysis Patients At The Point G Hospital]

INTRODUCTION

Cardiovascular abnormalities are frequent and often early, severe and masked in patients with renal impairment. These cardiovascular complications are the main causes of death in hemodialysis patients. The diagnosis of these cardiovascular anomalies by cardiac ultrasound allows the individualization of patients at high cardiovascular risk. We conducted this study to evaluate the echo-cardiographic aspects of chronic hemodialysis in the nephrology and hemodialysis department of the G-Point CHU.

METHODS

This is a retrospective study of chronic renal failure patients who have undergone extra-renal treatment for 6 months or more from January 1, 2011 to December 31, 2012. Results: During this study, 83 files were retained The sex ratio was 1.51 in favor of men. The average age of patients was 48 years old. HTA (59%) and tobacco (43.3%) remain the dominant risk factors. Vascular nephropathy was the leading cause of CKD, 44.6%. Echo-cardiac abnormalities are dominated by cavitary dilatation (78.3%), LVH (41%), cardiac dysfunction (83.2%), valvular lesion (30.1%), and pericarditis (22,9%). The cardiovascular complications were LVH (41%), hypertension (25.3%) and dilated cardiomyopathy (9.7%). The evolution was favorable for 73.5% of the patients, the mortality represented 8.4% with various complication (18.1%).

[Depression To The Chronic Hemodialysis Of the University Hospital OF Point G (Bamako-Mali)]

OBJECTIVE

Determine prevalence of the depression in a population of patients chronic hemodialysis. Look for the associated sociodemographic, clinical and biological factors.

METHOD

It was a transverse study. She concerned the at least 18-years-old patients, followed in the center of Hemodialysis of the CHU at the rate of 2 - 3 sessions a week. The patients having agreed, were in dialysis at least for 3 months and benefited from an individual interview through an index card of investigation based of Hamilton's scale French version in 17 items.

RESULTS

On a sample of 107 patients, the average age was 43, 24 ± 14 years old with extremes between 20 and 75 years. The average duration in dialysis was of ±40, 37 36, 5 months with extremes between 4 and 144 months. Prevalence of the depression was 88 %. The depression was light in 78, 5 %, moderated in 6,5% and severe in 3 %. The anemia was present at 94 patient's among whom 76 had a light depression.

CONCLUSION

We observed that prevalence of the depression remains high to the chronic hemodialysis.

[Direct cost of traumatic brain management in Hospital of Ségou Mali: What funding for care management in Mali?]

Traumatic Brain Injury (TBI) is the second cause of admission in the emergency department at the Nianankoro Fomba hospital of Ségou. Young adults with low income are the most affected. The objective of this study is to evaluate the direct cost of the management of TBI at the emergency ward and to make a proposal for future financing of this management in Mali. We conducted a prospective study from September 2009 to December 2010 at the Nianankoro Fomba hospital of Ségou. All patients admitted in the emergency ward for TBI for more than 24 hours were included. The age range between 21-40 was the most affected. All socioprofessional categories were affected. The average cost of prescription was 55,392 CFA. Medical evacuation was necessary in 15 cases for an average fee of 60,700 CFA. Due to lack of money, 75% of deceased patients were not evacuated at the third level. The average cost of management was 99,385 CFA [range: 39,115-282,944]. The total cost of services was 7,269,320 CFA. The high cost of the management of TBI is a major determinant of morbidity and mortality of this disease.

[Volvulus of sigmoid colon: surgical treatment and prognosis in the services of General Surgery of the Point G Teaching Hospital]

OBJECTIVE

To study the therapeutic aspects and prognosis of volvulus of the sigmoid colon in surgical departments.

PATIENTS AND METHODS

Our study was retrospective from January 2000 to December 2009 (10 years). All patients who underwent sigmoid volvulus in the Point G teaching hospital surgical departments were taken into account.

RESULTS

We recorded 96 patients operated for volvulus of sigmoid over 882 cases of bowel obstruction, a rate of 10.9%. The average age was 47.2 years ± 18.9. In per-operative, there was a necrosis of the colon rate of 16.7% (14 cases). Performed surgical treatment modalities were: sigmoidectomy with primary anastomosis in 29.2% of cases (28), sigmoidectomy followed by colostomy and secondary anastomosis in 60.4% of patients (58) and 10.4% rare of simple devolvulation. The immediate postoperative period were marked by a morbidity rate of 7.3% (7 cases) and a mortality rate of 7.3% (7 cases).

CONCLUSION

In spite of various therapeutic modalities of volvulus of the sigmoid colon, the rates of postoperative morbidity and mortality are rising in the general surgery of the Point G teaching Hospital.

[Common mesentery: discovered two cases of intestinal obstruction]

The purpose of this study was to describe the common mesentery in its occlusive form and practice driving before this emergency. The mesentery is a common abnormality of rotation of the primitive intestinal loop or omphalomesenteric loop during embryonic development. Two cases of intestinal obstruction by strangulation were received in urgency. They were a 55 year old man who checked himself into the emergency department and a 14 year old girl brought in by her parents. These were 2 cases of acute intestinal obstruction on incomplete common mesentery. The intestine was turned to complete common mesentery in both cases. Embryologically, it is anomalies of rotation and joining of the primitive intestine that are causing the incomplete common mesentery , the source of acute intestinal obstruction due to strangulation.

CONCLUSION

The common mesentery poses a diagnostic and therapeutic problem. Its symptomatology is that of occlusion by strangulation and the surgeon must note this before any obstruction.

[Postoperative peritonitis in the Surgery B department of the Point G hospital]

OBJECTIVE

To determine the incidence of postoperative peritonitis, and describe their clinical, paraclinical and therapeutic aspects.

PATIENTS AND METHODS

This was a retrospective study conducted between 1980 and 2010 in the Department of Surgery B of the Point G University Hospital. It focused on all patients who underwent surgical intra-abdominal in the Surgery B department.

RESULTS

We collected 25 cases of postoperative peritonitis, 84% were male subjects. The average age of patients was 37.2 years ± 17.0. The clinical picture was dominated by abdominal pain (92%), abdominal defense (92%), and fever (84%). Abdominal ultrasound played an important role in diagnosing 72% of cases. Etiologies were dominated by anastomotic leak (32%), infection of the collection phrenic, iatrogenic perforation (28%). Interventions made at surgery were: suture of the perforation or anastomotic recovery plus peritoneal cleansing and drainage in 36% of cases, peritoneal cleansing and drainage in 36%. There were postoperative complications in five patients. The mortality rate was 4%.

CONCLUSION

Postoperative peritonitis are rare in our service. When they occur their rate of morbidity and mortality are high.

[Head and neck injuries: 184 cases in Mali]

This prospective descriptive study was carried out from August 2007 to January 2008 in the emergency surgery department of Gabriel Touré Hospital in Bamako, Mali. A series of 184 patients treated for head and neck injuries was compiled. Patients presenting strictly neurosurgical lesions were excluded. Most of the patients included in this series were young single city-dwelling males (mean, age, 27 years; M/F sex ratio, 4.3. Most injuries were sustained in road traffic accidents (93%). The most common injuries were epistaxis and multiple fractures of facial bones, cervical spine and petrosal bone. These injuries ere often associated with avulsive wounds involving the external ear and nose. The main complication risks fell into four categories, i.e., circulatory loss, upper airway obstruction, functional and/or morphological impairment, and coma-related death (Glasgow score < 8). Shortage of medication and/or disposable treatment kits was a major handicap for optimal management of head and neck injuries.

[Urinary lithiasis in children: a study of 20 cases]

PURPOSE

To report the cases of urolithiasis in children and to assess epidemiological, clinical and therapeutically aspects.

PATIENTS AND METHODS

We study retrospectively the cases of urolithiasis in children of 0 to 15 years old between 2003 and 2008. The parameters of study were: age, sex, clinical and therapeutically aspects.

RESULTS

We report 20 cases. The mean age was 5.4 years. The sex-ratio was 9/1. Dysuria was the most common symptom. Abdominal plain radiography associate with ultrasonography permitted the diagnostic in most cases. Stone location was in the bladder mainly (n = 12). Posterior Urethra valves were the common etiology found. The surgical treatment was performed in all cases and consisted of cystolithotomy in the majority.

CONCLUSION

Children urinary stones are less common than in adults. The etiologies are different but the treatment is coming to be alike.

Establishing an insect disease vector functional genomics training center in Africa

The genome sequences for many insects vector of human diseases are now available and promise the development of a set of new, powerful tools that can be used to develop innovative approaches to control these diseases. The African continent, which is the most severely affected by vector borne diseases, lacks adequate infrastructures and personal resources required for rational use of genomic information. To fill this gap, the African Center for Training in Functional Genomics of Insect vectors of Human Disease (AFRO VECTGEN) was initiated by WHO/TDR and the Department of Medical Entomology and Vector Ecology (DMEVE) of the Malaria Research and Training Center (MRTC) in Mali. The aim of the AFRO VECTGEN program is to train young scientists in functional genomics who will ultimately use genome sequence data for research on insect vector of human disease. The program could trigger collaborative research and will benefit from an existing vector biology network in Mali, which was built around research grants funded by the National Institutes of Health, USA and WHO/TDR.

[Use of antiretroviral drugs invoices for the follow-up of a treatment programme. Example in Abidjan, Côte d'Ivoire]

A retrospective analysis of the prescriptions of the ARV treatment programme in Abidjan, Côte-d'Ivoire enabled the authors to assess the collected anonymous information in order to evaluate the efficacy of the programme. This collection of information helps to supervise each center at a lower cost, to alert on some working problems and to follow the quality of the observance. This supervision is possible regardless of the health care places, it can be carried out systematically from the administrative or financial services. In this study this follow-up reveals some problems.

[Assessment of a programme of prevention of mother-to-child transmission of HIV in Abidjan, Ivory Coast (1999-20002)]

The purpose of this article is to report the results of a programme for prevention of mother-to-child transmission (PMCT) of HIV conducted from 1999 to 2002 by the PNLS in Abidjan, Ivory Coast. This programme was supported by grants from the Fonds de solidarité international (FSTI) and the Glaxo Smith Kline (GSK) Foundation. After pre- and posttest counselling, pregnant women from 4 PMI centres underwent screening for HIV. Seropositive women were offered short course AZT and the possibility of financial assistance for breast-feeding. All programme activities were carried out in close cooperation with association members. A total of 22466 tests were given and 18116 women returned for results. Among the 1829 seropositive women to whom PMCT intervention was proposed, 667 received short course AZT. The rate of transmission at 18 months was 162%. In addition 69 mothers and 28 children eligible for ARV therapy benefited from tritherapy. Limiting factors, at each phase, and efficacy of intervention were analyzed.

[Syphilis test proposed within the context of a programme to reduce mother/child HIV transmission: example of the Wassakara Health Care Center in Abidjan]

During the program MTCT+ set up in Abidjan by the national authorities with the assistance of the FSTI and FGSK, free screening and treatment of the syphilis infection were proposed to pregnant women. One test of agglutination on blades VDRL (Carbon Antigen Biotec the U.K.) and one TPHA test on plates for the positive VDRL (TPHA Nosticon Biomérieux F) were performed. Over the period from June 1999 to December 2001, 4 320 samples were taken. The laboratory observed 84 positive tests VDRL and 59 confirmed by TPHA, that is to say a syphilis seroprevalence (TPHA) of 1.4%. In addition 391 results were not available for various reasons (errors of numbering, haemolysed blood, absence of reagents, etc.) ie. 9.0%. Among the 59 positive women (TPHA), 30 came back for their result and 23 women were correctly treated (3 or 4 penicillin delay injections). In addition 7 partners received a complete treatment and 8 incomplete treatment. The cost of each detected and treated case rose approximately to 150 Euros, which is relatively low except in time/ staff and indirect costs for women. This study confirmed that all the activities of SMI must be integrated to have an efficient PTME programme. The biological assessment must be accessible as a whole, to minimize the additional costs and transportations. A training of all the personnel in 2002 helped to improve in an important way the results of the intervention in the center.

Ultrastructure of Right Ventricular Myocardium Subjected to Acute Pressure Load

BACKGROUND

Ultrastructural data on acute right ventricular pressure load in pigs are rare.

MATERIALS AND METHODS

In control (n = 7) and banding groups (n = 6), right ventricular pressure (micromanometry) and function (sonomicrometry) were measured. Right ventricular pressure was increased 2.5-fold in the banding group by pulmonary artery constriction. Right ventricular biopsies were taken at baseline and after 6 h and processed for electron microscopy. Parameters of cellular injury were determined stereologically. Three perfusion -fixed hearts were investigated qualitatively in each group.

RESULTS

Stereology revealed an increase in the sarcoplasmic volume fraction and the cellular edema index in the banding group ( p < 0.05). Mitochondrial surface-to-volume ratio and volume fraction did not show significant alterations. Subendocardial edema and small amounts of severely injured myocytes were observed in the perfusion-fixed hearts after banding. Ultrastructure was normal in controls. After an initial increase, the right ventricular work index declined progressively in the banding group but remained unchanged in controls.

CONCLUSIONS

Ultrastructural alterations resulting from acute right ventricular pressure load were characterized by edema of subendocardial myocytes and single cell necrosis. Focal adrenergic overstimulation and mechanical stress are probably more relevant in the pathogenesis of these lesions than ischemia.