Clinical, paraclinical and genetic aspects of autosomal recessive cerebellar ataxias (ARCA) in Mali

Introduction

Autosomal recessive cerebellar ataxias (ARCA) are a group of rare and heterogynous neurodegenerative diseases mainly characterized by unbalance and walking difficulty and movement incoordination.

Objectives

To clinically and paraclinically characterize ARCA in the department of Neurology at the Teaching Hospital of Point G and identify the underlying genetic defect.

Patients and method

We have conducted a longitudinal and prospective study from January 2018 to December 2020. Patients with ARCA phenotype seen in the Department of Neurology at the Teaching Hospital of Point "G" were enrolled.

Results

We have enrolled 7 families totaling 13 patients after giving an informed verbal and written consent. The sex ratio was 2.2 in favor of males, Kayes region and Fulani ethnic group were respectively the most represented region and ethnic group.Walking difficulty represented the major symptom followed by loss of vibration and joint sense, nystagmus, dysarthria and skeletal deformities. Alpha-foetoprotein level was high in one patient. Genetic testing confirmed Friedreich ataxia in one family and was not conclusive in 4 families.

Conclusion

This study showed that ARCA are not uncommon in Mali and genetic testing is crucial to confirm the diagnosis.

Household costs associated with seeking malaria treatment during pregnancy: evidence from Burkina Faso and The Gambia

Background

Malaria in pregnancy remains a major health threat in sub-Saharan Africa to both expectant mothers and their unborn children. To date, there have been very few studies focused on the out of pocket costs associated with seeking treatment for malaria during pregnancy.

Methods

A cross-sectional survey was undertaken in Burkina Faso and The Gambia to estimate the direct and indirect costs associated with outpatient consultations (OP) and inpatient admissions (IP). Direct costs were broken down into medical (admission fees, drug charges, and laboratory fees), and non-medical (transportation and food). Indirect costs reflected time lost due to illness. In total, 220 pregnant women in Burkina Faso and 263 in The Gambia were interviewed about their treatment seeking decisions, expenditure, time use and financial support associated with each malaria episode.

Results

In Burkina Faso 6.7% sought treatment elsewhere before their OP visits, and 27.1% before their IP visits. This compares to 1.3% for OP and 25.92% for IP in The Gambia. Once at the facility, the average direct costs (out of pocket) were 3.91US$ for an OP visit and 15.38US$ of an IP visit in Burkina Faso, and 0.80US$ for an OP visit and 9.19US$ for an IP visit in The Gambia. Inpatient direct costs were driven by drug costs (9.27US$) and transportation costs (2.72US$) in Burkina Faso and drug costs (3.44 US$) and food costs (3.44 US$) in The Gambia. Indirect costs of IP visits, valued as the opportunity cost of time lost due to the illness, were estimated at 11.85US$ in Burkina Faso and 4.07US$ in The Gambia. The difference across the two countries was mainly due to the longer time of hospitalization in Burkina Faso compared to The Gambia. In The Gambia, the vast majority of pregnant women reported receiving financial support from family members living abroad, most commonly siblings (65%).

Conclusions

High malaria treatment costs are incurred by pregnant women in Burkina Faso and The Gambia. Beyond the medical costs of fees and drugs, costs in terms of transport, food and time are significant drivers. The role of remittances, particularly their effect on accessing health care, needs further investigation.

[Clinical and laboratory features of recessive Limb Girdle Muscular dystrophies in the Department Neurology of University Hospital of Point G]

INTRODUCTION

Limb-Girdle Muscular dystrophies (LGMD) is a group of inherited diseases characterized by predominantly proximal and limb muscle weakness. These are rare diseases that have not been well studied in sub-saharan Africa. The aim of our was the clinical and paraclinical characterization of patients with recessive LGMD at the Department of Neurology of the Teaching Hospital of Point G.

PATIENTS AND METHODS

We conducted a longitudinal prospective study which took place from March 2014 to May 2019. Patients with recessive LGMD phenotype were enrolled. Sociodemographic, clinical and laboratory data were analyzed.

RESULTS

We enrolled 46 families (67 patients), i.e. a frequency of 16.7% among the neurodegenerative diseases seen in the service. Among them, 45.6% came from the Sikasso region. Autosomal recessive inheritance pattern was suspected in 67.4% of the families. Symptoms appeared mainly in the first decade of life. Proximal muscle weakness was found in almost all patients. Cardiac examination showed dilated cardiomyopathy in 4.5% of cases.

CONCLUSION

Limb-Girdle muscular dystrophy is a disabling disease that is found in Mali. Further study of these cases could elucidate the underlying genetic defects.

[Socio-demographic, clinical, and therapeutic aspects of adolescents treated and followed for HIV infection at the Hospital Gabriel Toure paediatric center]

HIV infection is a chronic infectious disease requiring long-term management and regular follow-up of patients.

OBJECTIVES

The aims of this study was to describe the socio-demographic, clinical, biological and therapeutic aspects of adolescents treated and followed for HIV infection at the Hospital Gabriel Toure paediatric center.

PATIENTS AND METHODS

From 01/01/2001 to 31/12/2017, the medical records of children followed for HIV infection until adolescence were analyzed. It was a descriptive and analytical retrospective study.

RESULTS

One thousand five hundred and fourteen patients received antiretroviral treatment and 587 were still in follow-up on 31 December 2017, including 393 adolescents (sex-ratio = 1.2). The median age was 14.25 years and 55.1% of children had lost at least one parent. HIV serology was positive among mothers in 61.7% of cases (n=342), and 63% of them were on ARVs. Sixty-eight per cent of children were WHO Stage III or IV at the time of ART initiation. The median age at onset of ART was 53 months (26-96 months). The combination of 2 nucleotide reverse transcriptase inhibitors (NRTIs) with a non-nucleotide reverse transcriptase inhibitor (NNRTI) was used in 89% of patients. The median CD4 count before ARV treatment was 438/mm3. The average duration of follow-up under treatment was 9.8 ± 3.4 years. Fifty-one percent of adolescents had undetectable viral load. There was a correlation between the initiation of a second line of treatment and treatment failure (p<0.001).

CONCLUSION

The adherence of adolescents to ARV treatment requires the implementation of innovative strategies to improve the therapeutic success rate.

[Infectious lung disease has sars cov2 complicated meningism on type 2 diabetes field: about a case]

INTRODUCTION

Sars Cov 2 infection is a complex viral infectious lung disease that can be complicated by damage to other organs.

CASE REPORT

This is a type 2 diabetic patient, overweight and hypertensive, who consults in an emergency for a meningeal syndrome in a context of fever and cough, in whom laboratory and para-clinical investigations have concluded diagnosis of severe Sars cov2 pneumonia complicated by meningeal syndrome. Resuscitation under antibiotic therapy and immunosuppressant treatment associated with risk factor treatments led to a cure without serious complications.

CONCLUSION

Sars Cov 2 pneumonia complicated by meningism is serious, early management combining antibiotic therapy and immunosuppressive treatment improves the prognosis.

[Surgery wound infection at surgery "A" department of the University Hospital Point G]

AIM

To determine the frequency of the surgery wound infection, its favoring factors, causative germs and its antibiotic treatment of choice in the surgery "A" department of the University Hospital Point G.

METHOD

In a retrospective descriptive study over a 6-month period in the surgery "A" department of the University Hospital Point G, we enrolled all patients who underwent surgery necessitating at least 48 hours of hospital admission during our study period and in conformity with the Atlanta CDC criteria. Surgery patients with less than 48 hours postoperative hospital stay and those admitted to the hospital without surgery were not included.After the surgery, the nature and location of the infection have been clarified. In this work, ethical considerations have been respected and there is no conflict of interest.

RESULTS

Two hundred and sixty-five (n=265) patient files were collected including 24 cases of surgery wound infection (a hospital frequency of 9%. The average age was 41.41 years (y.o) old with extremes of 7 y.o and 102 y.o. The sex ratio was 0.9 in favor of women. The commonly studied pathologies were digestive surgery in 52.8%, gynecological surgery in 24.5%, etc… Patients were seen in regular outpatient surgery visits in 75.8% and surgical emergencies in 24.2%. Of the patients urgently admitted, 26.5% presented an ISO; for those received in ordinary consultation it was 3.48%. Fifteen (15) cases were classified ASA III and two (2) ASA II. Based on the Altemeier classification, surgery was clean in 66.8% of our patients, contaminated clean in 12.4%, contaminated in 12.1%, and dirty in 8.7% (including half resulting in surgery wound infection). In total, 79% of patients whose surgeries lasted more than two (2) hours presented a surgery wound infection. Postoperative infection of patients was superficial in 58.3% and deep in 33.3%. In 8.3% of cases, it was a space infection. At the cytobacteriological examination of the pus from the operative site, Escherichia coli (E. coli) was the most common germ with 58.3%. E. coli was sensitive to amoxicillin-clavulanic acid in 57.14%. Surgically, a re-intervention was performed in 20.8% of cases, a secondary suture in 12.5%, and a single dressing in 66.7%. The average postoperative stay was 6.5 days with extremes of 2 days and 69 days. In 3 months postoperatively we recorded 4 cases of death.

CONCLUSION

The surgery wound infection constitutes a major complication in a surgical environment starting with surgical act itself.Particular emphasis should be placed on prevention, which will reduce the risks of ISO occurrence.

[Syndrome Of 46, XX Male With Sex-Determining Region Of Y (SRY) Chromosome Missing, Bilateral Gynecomastia And Complete Virilization: About A Case]

Absent SRY gonadal dysgenesis (negative) is the set of clinical and biological manifestations linked to the lack of development of the testes in humans. Authors report the first case of gonadal dysgenesis SRY-negative 46, XX male with gynecomastia documented in Mali.

CASE OBSERVATION

This is a 15 years old boy of a deaf-mute brother, no family consanguinity. He was referred to the hospital because of severe bilateral gynecomastia. Hypergonado-tropic hypogonadism condition was investigated by hormonal laboratory assessment and the result of cytogenetic analysis carried out in France revealed a karyotype SRY-negative 46, XX isch Yp11, 3. The patient received psychological assistance and substitutive treatment based on testosterone. Reconstructive surgery was also conducted to correct urogenital malformations.

CONCLUSION

Diagnosis of 46, XX male syndrome is rare and need cytogenetic analysis. In Mali, cost and availability of this technique make diagnosis difficult and care inadequate for patients.

Evaluation of the oral health of pregnant women in prenatal consultations in Côte d’Ivoire

Background

Despite the proven links between oral health status and adverse pregnancy outcomes, oral examination is not systematically integrated into prenatal examinations in Côte d’Ivoire. In addition, there are no prevention messages specifically targeted at pregnant women. Objective: To assess the oral health of pregnant women in Côte d’Ivoire.

Methods

A cross-sectional survey was conducted at the Maternal and Child Health Department of the National Public Health Institute in Abidjan. The data collected were: age, education level, marital status, source of income, trimester of pregnancy, gestational age, oral hygiene habits and the fact that they whether or not received oral health information. A clinical examination was conducted to assess oral hygiene (OHIS index), periodontal condition (CPI index), dental condition (DMFT index), as well as the presence of epulis, erosion or dental mobility. Frequencies and counts were calculated for the different variables in the study.

Results

A total of 207 women were observed. The age range was 15 to 44 years with 14.0% under 19 years old. The majority were in couple (76.8%), multi-gesture (77.3%), and more than half had no education (52.2%) or source of income (56.0%); 50.7% snacked between meals and 33.3% had vomiting. They brushed their teeth at least twice a day (70.0%) and had not changed their oral hygiene habits (77.3%) during this pregnancy. Only 3.4% had information on oral health conditions during pregnancy. The frequency of caries was 75.4%, dental erosions 13.0%, gingivitis 57.0%, periodontitis 6.8% and epulis 3.4%.

Conclusions

The results suggest the integration of systematic dental consultation into prenatal consultations in order permit the sensitization of these women, screening and management of their oral conditions.

Key messages

Oral diseases of pregnant women are a reality without their knowledge in Côte d’Ivoire. A systematic dental visit is essential during prenatal consultations in Côte d’Ivoire.

Neural circuit repair by low-intensity magnetic stimulation requires cellular magnetoreceptors and specific stimulation patterns

Although electromagnetic brain stimulation is a promising treatment in neurology and psychiatry, clinical outcomes are variable, and underlying mechanisms are ill-defined, which impedes the development of new effective stimulation protocols. Here, we show, in vivo and ex vivo, that repetitive transcranial magnetic stimulation at low-intensity (LI-rTMS) induces axon outgrowth and synaptogenesis to repair a neural circuit. This repair depends on stimulation pattern, with complex biomimetic patterns being particularly effective, and the presence of cryptochrome, a putative magnetoreceptor. Only repair-promoting LI-rTMS patterns up-regulated genes involved in neuronal repair; almost 40% of were cryptochrome targets. Our data open a new framework to understand the mechanisms underlying structural neuroplasticity induced by electromagnetic stimulation. Rather than neuronal activation by induced electric currents, we propose that weak magnetic fields act through cryptochrome to activate cellular signaling cascades. This information opens new routes to optimize electromagnetic stimulation and develop effective treatments for different neurological diseases.

Artemisinin-based combination therapy during pregnancy: outcome of pregnancy and infant mortality: a cohort study

BACKGROUND

The World Health Organization (WHO) recommendation of treating uncomplicated malaria during the second and third trimester of pregnancy with an artemisinin-based combination therapy (ACT) has already been implemented by all sub-Saharan African countries. However, there is limited knowledge on the effect of ACT on pregnancy outcomes, and on newborn and infant's health.

METHODS

Pregnant women with malaria in four countries (Burkina Faso, Ghana, Malawi and Zambia) were treated with either artemether-lumefantrine (AL), amodiaquine-artesunate (ASAQ), mefloquine-artesunate (MQAS), or dihydroartemisinin-piperaquine (DHA-PQ); 3127 live new-borns (822 in the AL, 775 in the ASAQ, 765 in the MQAS and 765 in the DHAPQ arms) were followed-up until their first birthday.

RESULTS

Prevalence of placental malaria and low birth weight were 28.0% (738/2646) and 16.0% (480/2999), respectively, with no significant differences between treatment arms. No differences in congenital malformations (p = 0.35), perinatal mortality (p = 0.77), neonatal mortality (p = 0.21), and infant mortality (p = 0.96) were found.

CONCLUSIONS

Outcome of pregnancy and infant survival were similar between treatment arms indicating that any of the four artemisinin-based combinations could be safely used during the second and third trimester of pregnancy without any adverse effect on the baby. Nevertheless, smaller safety differences between artemisinin-based combinations cannot be excluded; country-wide post-marketing surveillance would be very helpful to confirm such findings. Trial registration ClinicalTrials.gov, NCT00852423, Registered on 27 February 2009, https://clinicaltrials.gov/ct2/show/NCT00852423.

The assessment of gestational age: a comparison of different methods from a malaria pregnancy cohort in sub-Saharan Africa

BACKGROUND

Determining gestational age in resource-poor settings is challenging because of limited availability of ultrasound technology and late first presentation to antenatal clinic. Last menstrual period (LMP), symphysio-pubis fundal height (SFH) and Ballard Score (BS) at delivery are therefore often used. We assessed the accuracy of LMP, SFH, and BS to estimate gestational age at delivery and preterm birth compared to ultrasound (US) using a large dataset derived from a randomized controlled trial in pregnant malaria patients in four African countries.

METHODS

Mean and median gestational age for US, LMP, SFH and BS were calculated for the entire study population and stratified by country. Correlation coefficients were calculated using Pearson's rho, and Bland Altman plots were used to calculate mean differences in findings with 95% limit of agreements. Sensitivity, specificity, positive predictive value and negative predictive value were calculated considering US as reference method to identify term and preterm babies.

RESULTS

A total of 1630 women with P. falciparum infection and a gestational age > 24 weeks determined by ultrasound at enrolment were included in the analysis. The mean gestational age at delivery using US was 38.7 weeks (95%CI: 38.6-38.8), by LMP, 38.4 weeks (95%CI: 38.0-38.9), by SFH, 38.3 weeks (95%CI: 38.2-38.5), and by BS 38.0 weeks (95%CI: 37.9-38.1) (p < 0.001). Correlation between US and any of the other three methods was poor to moderate. Sensitivity and specificity to determine prematurity were 0.63 (95%CI 0.50-0.75) and 0.72 (95%CI, 0.66-0.76) for LMP, 0.80 (95%CI 0.74-0.85) and 0.74 (95%CI 0.72-0.76) for SFH and 0.42 (95%CI 0.35-0.49) and 0.77 (95%CI 0.74-0.79) for BS.

CONCLUSIONS

In settings with limited access to ultrasound, and in women who had been treated with P. falciparum malaria, SFH may be the most useful antenatal tool to date a pregnancy when women present first in second and third trimester. The Ballard postnatal maturation assessment has a limited role and lacks precision. Improving ultrasound facilities and skills, and early attendance, together with the development of new technologies such as automated image analysis and new postnatal methods to assess gestational age, are essential for the study and management of preterm birth in low-income settings.

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

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

MATERIAL AND METHOD

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

RESULTS

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

CONCLUSION

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

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

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

PATIENTS AND METHODS

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

RESULTS

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

CONCLUSION

Induced singleton pregnancy is a high-risk pregnancy.

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

INTRODUCTION

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

[CT Scan Angiography In The Pulmonary Embolism's Diagosis At Radiology And Nuclear Medicine Department In Hôpital Du Point "G"]

OBJECTIVE

The aim of this study was to precise the role of thoracic CT angiography in the diagnosis of pulmonary embolism in our practice.

PATIENTS AND METHODS

We conduct a prospective eight (8) month study in the radiology department of the Teaching Hospital of Point "G" Seventy seven patients suspected of pulmonary embolism were included. A thoracic CT angiography was performed in emergency after chest X ray for each patient. Pulmonary embolisms were classified according to the Qanadli index.

RESULTS

The average age of our patients was 52 years old (23 - 85 years). The age group 55-64 was predominant. The clinical probability was low, medium and high respectively in 8,9%, 28,9% and 62,33%. Chest X ray was suspect of embolism in 92,2% (71/77%), thoracic CT angiography was positive in 58,44% (45/77). Embolism was located in a lobar pulmonary artery in 57,78% and the right side was the most concerned. Among the cardiopulmonary consequences, dilatation of the trunk of the pulmonary artery predominated in 42,22% of cases. According to Qanadli index, the severity of pulmonary embolism was moderate (53;33%), severe (35,56%), and massive (11,11%).

CONCLUSION

CT angiography is in our practice, the best choice in the diagnosis of pulmonary embolism. It allows to confirm the diagnosis, and to precise the topography of pulmonary embolism. In addition, this examination makes it possible the severity specification of the affection.

[Targeted newborn screening for sickle-cell anemia: Sickling test (Emmel test) boundaries in the prenatal assessment in West African area]

BACKGROUND

Newborn screening for sickle cell anemia is necessary in Africa where the disease is more frequent. Hemoglobin electrophoresis is used for screening, but is limited by a high cost and difficult access. Sickling test (Emmel test), which is more affordable and technically more accessible, is often requested for prenatal assessment of pregnant women in West African areas to reserve screening for newborns from mothers in whom the positive sickling test attests the presence of hemoglobin S. This study aims to evaluate the number of undetected sickle cell anemia newborns by a screening policy targeting only newborns from mothers in whom a sickling test would have been positive.

METHODS

From 2010 to 2012, in Bamako, Mali, West Africa, 2489 newborns were routinely screened for sickle cell anemia at the umbilical cord or heel by isoelectrofocusing and, if necessary, by high-performance liquid chromatography. These newborns were born from 2420 mothers whose hemoglobin was studied by isoelectrofocusing. The data was recorded and processed using Excel software version 14.0.0. We calculated the frequency of the sickle cell gene in mothers and newborns as well as the number of SCA newborns from heterozygous or C homozygous mothers.

RESULTS

Of the 2489 newborns, 16 had sickle cell anemia (6 SS and 10 SC); 198 had the sickle cell trait; 139 were AC and 1 was CC. Of the 10 newborns with SC profile, 3 were born from mothers not carrying the S gene but the C gene of hemoglobin and in which an Emmel test would have been negative.

CONCLUSION

Targeted newborn screening, based on the results of sickling test in pregnant women, would misdiagnose more than one of six sickle cell anemia newborns who would not benefit from early care. Cost-effectiveness studies of routine newborn screening for sickle cell anemia should lead to a better screening strategy in contexts where hemoglobin S and other hemoglobin defect genes coexist.

Preliminary results of the induced membrane in upper limb. About 6 cases

The aim of this study was to describe the preliminary results after reconstruction of segmental bone defects (SBDs) in the upper limb of six patients. This retrospective study included three men and three women with an average age of 35years (range 18-62years), who had four primary and two secondary SBDs. The average length of the SBD was 4.5 cm (2-10cm). According to the SOFCOT classification, type I (1 case), type II (4 cases) and type III (1 case) defects were identified. The reconstruction involved the humerus in two cases and the forearm bones in four cases. A posterior plaster cast was applied in all patients during the first stage of treatment. Internal fixation was used during the second phrase (five plates, one K-wire). The mean time elapsed between the first and the second stages of treatment was 3 months (2-4 months). At the final follow-up, bone union was obtained in five patients after an average of 4.6 months (4-6 months). The progression was favorable after the first stage of the induced membrane technique. However, two cases of sepsis were observed after the second stage of treatment, one evolving to osteitis that caused graft resorption. The induced membrane technique is a sequential technique used for treating SBDs. It is an alternative method of bone reconstruction in the upper limb.

Maternal and perinatal outcomes associated with a trial of labour after previous caesarean section in sub-Saharan countries

OBJECTIVE

To assess the risks of uterine rupture, maternal and perinatal outcomes associated with a trial of labour (TOL) after one previous caesarean were compared with having an elective repeated caesarean section (ERCS) without labour in low-resource settings.

DESIGN

A prospective 4-year observational study.

SETTING

Senegal and Mali.

SAMPLE

A cohort of 9712 women with one previous caesarean delivery.

METHODS

Maternal and perinatal outcomes were compared between 8083 women who underwent a TOL and 1629 women who had an ERCS. Perinatal and maternal outcomes were then stratified according to the presence or absence of risk factors associated with vaginal birth after caesarean section. These outcomes were adjusted on maternal, perinatal and institutional characteristics.

MAIN OUTCOME MEASURES

The risks of uterine rupture, maternal complication and perinatal mortality associated with TOL after one previous caesarean as compared with ERCS, RESULTS: The risks of hospital-based maternal complication [adjusted odds ratio (OR) 1.52; 95% CI 1.09-2.13; P = 0.013] and perinatal mortality (adjusted OR 4.53; 95% CI 2.30-9.92; P < 0.001) were significantly higher in women with a TOL compared with women who had an ERCS. However, when restricted to low-risk women, these differences were not significant (adjusted OR 0.90, 95% CI 0.55-1.46, P = 0.68, and adjusted OR 1.13; 95% CI 0.75-1.86; P = 0.53, for each outcome, respectively). Uterine rupture occurred in 25 (0.64%) of 3885 low-risk women compared with 70 (1.66%) of 4198 women with unfavourable risk factors.

CONCLUSION

Low-risk women have no increased risk of maternal complications or perinatal mortality compared with women with one or more unfavourable factors.

TWEETABLE ABSTRACT

Low-risk women have a lower risk of maternal complications or perinatal mortality compared with high-risk women.

[Problem of the referral-for-referral system of obstetrical emergencies and the community involvement in the Bamako district]

AIMS

This study aims to evaluate the difficulties of the referral-for-referral system in the V municipality sanitary district of Bamako.

PATIENTS AND METHOD

A descriptive cross-sectional study was carried out from 5th September to 5th November 2011 in the sanitary district of the V municipality in Bamako. Included in the study were patients referred or evacuated for obstetrical care in the health center during the period of study. Not included were the patients referred or evacuated from other sanitary districts and patients referred or evacuated or self-referred for no obstetrical reasons. Data was recorded on the Excel 8.0 software and analyzed on the software packages Epi info 3.5.3 and STATA.

RESULTS

During the period of study we recorded 1824 deliveries among which 180 fit the inclusion criteria. During our study 92.2% of references were adequate; 78.3% were justified and 72.2% were opportune. Only the sanitary district of the V Municipality had paid its quotation due at the time of the study.

CONCLUSION

Our study showed that inadequate logistics and the lack of involvement of communities hamper the proper functioning of the referral system.

[Epidemiology of bacillary pulmonary tuberculosis according to HIV status of patients followed in the department of infectious diseases Conakry (Guinea)]

Despite many efforts of prevention and the availability of free treatment, TB/HIV co-infection is still rampant in Guinea. The objective of this study was to describe the epidemiology of smear positive pulmonary tuberculosis according to HIV status among patients hospitalized in the infectious diseases department of Conakry University Hospital. This was a descriptive and analytical retrospective study of patient records admitted for pulmonary tuberculosis from January 2003 to December 2012. During this period, 1953 cases of tuberculosis were collected of which 346 (17.7%) were smear positive. There was a marked male predominance (59.7%). The average age was 38 ± 11 years. The majority of patients originated from the suburbs of Conakry and its surrounding prefectures (76.7%). People without profession were most represented (40.7%). A level of primary education was the most frequently reported (39.7%). Out of 325 patients tested for HIV, the serology was positive in 185 patients (56.9%). A contact with a TB patient was reported in 21.4% of HIV negative patients, and in 6.5% of the HIV-positive group (p = 0.0006). There was no difference between the two groups regarding clinical signs and symptoms. The mean CD4 count was comparable in both groups (p = 0.05). Lethality was higher among co-infected patients (30.4% against 15.56%; p = 0.00037). Strengthening the prevention of TB among PLWHA by the administration of isoniazide seems necessary and warrants further study on this subject in Guinea.

[Frequency of glucose-6-phosphate dehydrogenase deficiency (A-376/202) in three Malian ethnic groups]

Erythrocyte G6PD deficiency is the most common worldwide enzymopathy. The aim of this study was to determine erythrocyte G6PD deficiency in 3 ethnic groups of Mali and to investigate whether erythrocyte G6PD deficiency was associated to the observed protection against malaria seen in Fulani ethnic group. The study was conducted in two different areas of Mali: in the Sahel region of Mopti where Fulani and Dogon live as sympatric ethnic groups and in the Sudanese savannah area where lives mostly the Malinke ethnic group. The study was conducted in 2007 in Koro and in 2008 in Naguilabougou. It included a total 90 Dogon, 42 Fulani and 80 Malinke ethnic groups. Malaria was diagnosed using microscopic examination after Giemsa-staining of thick and thin blood smear. G6PD deficiency (A-(376/202)) samples were identified using RFLP (Restriction Fragment Length Polymorphism) assay and analysis of PCR-amplified DNA amplicon. G6PD deficiency (A-(376/202)) rate was 11.1%, 2.4%, and 13.3% in Dogon, Fulani, and Malinke ethnic group respectively. Heterozygous state for G6PD (A-(376/202)) was found in 7.8% in Dogon; 2.4% in Fulani and 9.3% in Malinke ethnic groups while hemizygous state was found at the frequency of 2.2% in Dogon and 4% in Malinke. No homozygous state was found in our study population.We conclude that G6PD deficiency is not differing significantly between the three ethnic groups, Fulani, Dogon and Malinke.

[Cerebral miliary tuberculosis, a case study]

Cerebral miliary tuberculosis is a rare and serious disease due to the hematogenic spread of bacillus tuberculous. It occurs more often in a debility context. Stereotaxic biopsy allows to establish the final diagnosis. But, in most of the cases it is presumptive based on clinical and biological features, and the regression of symptoms under anti tuberculosis treatment, of which depends the vital prognosis. We report the case of an immunocompetent patient, smoker who presented with cerebral military.

[Domestic accidents: epidemiological aspects in a District of Bamako]

AIMS

To study the epidemiological, clinical and prognostic aspects of domestic accidents in the health center of reference of one district in Bamako.

MATERIEL AND METHODS

This was a cross-sectional study of domestic accidents received at the health center of reference of "commune V" in Bamako district from September 2009 to February 2010. All cases of domestic accident that came to the health center and followed up were included. The Chi² was used for the statistical test with P ≤ 0,05 considered significant.

RESULT

During the study period (September 2009 to February 2010), we gathered 192 cases of domestic accident for 7425 out patients or 2.6% of the reasons for consultation. The sex-ratio was 1.49 in favor of men. The occurrence of burns was more frequent in the age group 6-14 years and 15-24 years with respectively, p= 0,002 and p= 0.00002. Overall mortality was 2.6% and all deaths were due to the burn.

CONCLUSION

Domestic accidents are frequent and take an important place in overall reasons for admission. In this context, the burn is more responsible for deaths.

[Obstetric care in Mali: effect of organization on in-hospital maternal mortality]

BACKGROUND

Maternal mortality is still too high in sub-Saharan Africa, particularly in referral hospitals. Solutions exist but their implementation is a great issue in the poor-resources settings. The objective of this study is to assess the effect of the organization of obstetric care services on maternal mortality in referral hospitals in Mali.

METHODS

This is a multicentric observational survey in 22 referral hospitals. Clinical data on 42,929 women delivering in the 22 hospitals within the 2007 to 2008 study period were collected. Organization evaluation was based on explicit criteria defined by an expert committee. The effect of the organization on in-hospital mortality adjusted on individual and institutional characteristics was estimated using multi-level logistic regression models.

RESULTS

The results show that an optimal organization of obstetric care services based on eight explicit criteria reduced in-hospital maternal mortality by 41% compared with women delivering in a referral hospital with sub-optimal organization defined as non-compliance with at least one of the eight criteria (ORa=0.59; 95% CI=0.34-0.92). Furthermore, local policies that improved financial access to emergency obstetric care had a significant impact on maternal outcome.

CONCLUSION

Criteria for optimal organization include the management of labor and childbirth by qualified personnel, an organization of human resources that allows timely management of obstetric emergencies, routine use of partography for all patients and availability of guidelines for the management of complications. These conditions could be easily implemented in the context of Mali to reduce in-hospital maternal mortality.

[Hysterectomy: indications and advantages of the vaginal route in Mali]

The purpose of this report was to determine the frequency of hysterectomy and describe its indications and outcomes. A retrospective, descriptive study related to active hysterectomy of was conducted at the reference health centre of commune V in Bamako, Mali from January 1st, 2004 to December 31st, 2008. All hysterectomy patients with complete medical files were included. A total of 172 files were identified including 152 that were complete. Hysterectomy accounted for 1.38% of all interventions during the study period. The procedure was carried out in emergency in 0.14% and electively in 13.39%. Mean patient age was 47.9 +/- 11.7 years; 89 patients were older than 45 years. The indications for hysterectomy were complicated uterine fibroids in 82 patients, genital prolapse in 44, adenomyosis in 10, obstetrical hysterectomy in 13 and cervical dysplasia in 3. The abdominal route was used in 100 patients (65.8%) and the vaginal rout in 52 (34.2%). The duration of the procedure and hospital stay was longer after hysterectomy by the abdominal (p<0.05). Perioperative complications were observed in 17% of patients after abdominal hysterectomy versus 7.69% after vaginal hysterectomy. Two maternal deaths due to hemorrhagic shock were observed after obstetrical hysterectomy. Hysterectomy is a frequent intervention that is not without complication risks. Choice of route depends on the indication and skill of the operator. Although endoscopic surgery is still difficult to perform in developing countries, development of vaginal hysterectomy is necessary to reduce perioperative complications.

Clinical and genetic analysis of spinocerebellar ataxia in Mali

BACKGROUND

Autosomal dominant cerebellar ataxia, currently denominated spinocerebellar ataxia (SCAs), represents a heterogeneous group of neurodegenerative disorders affecting the cerebellum and its connections. We describe the clinical and molecular findings in 16 patients originating from Malian families, who suffer from progressive cerebellar ataxia syndrome.

METHODS AND RESULTS

Molecular analysis allows genetic profiles of SCA to be distinguished. In seven patients, SCA type 2 (CAG) mutation was expanded from 39 to 43 repeats. SCA type 7 (CAG) mutation was confirmed in six patients. Mutations were expanded from 49 to 59 repeats. In three patients, SCA type3 was diagnosed and CAG mutation was expanded to 73 repeats.

CONCLUSIONS

Our data suggest that the most frequent types of SCA are SCA2 and SCA7. However, further studies are needed to confirm these preliminary results.

[Epidemiogic and clinical profile of severe pre-eclampsia at the university hospital of Gabriel Touré]

AIMS

To determine the epidemio-clinical profile of severe pre-eclampsia.

PATIENTS AND METHOD

It was about a transversal study done from November 2005 to juin 2006 at the teaching hospital Gabriel Touré. Were included pregnant women with severe pre-eclampsia. Statistical analysis compared the proportions and means, the proportions were compared using the chi (2 with) P < 0,05 considered significant.

RESULTS

during the period of study, 130 cares of severe pré-eclamsia were brougthbto gether among 1667 pregnant women, which was 7,8 %.The mean age was 17.15 years with extremes of 15 and 42 years. The most frequent signs of severe preeclampsia were the association of epigastrium pain, nausea, vomiting and headaches in 54- 62 %.

CONCLUSION

Ther profile type severe pre-eclampsia is 17 years old pregnant women, of an uterus height between 33 and 36 cm, with an insuffisant number of prenatal consultation.

[Not Available]

The binding of the horns takes a place growing among the various processes of birth-control. This binding of the horns is almost irreversible and the women who make recourse to this method are generally saddles which think of having achieved their families.

[Stillbirths in the department of Obstetrics and Gynecology of the Health Center of Refers Common V (CSRef CV) of the district of Bamako]

OBJECTIVES

The aims of this study were to do an epidemiological study of the still birth and to analyze maternal pathologies and gynéco-obstétricales associated.

MATERIAL AND METHODS

We undertook a transverse exploratory study of January 1 to December 31, 2005, intended to count all the cases of still-born children in our service which they result from single or multiple pregnancy. We proceeded to one systematic audit of all the files of mortinaissance.

RESULTS

During the study period, we listed 7773 cases of births whose 390 still-born children is a frequency 50.1/1000. The Middle Age was of 26.3± 4 years, a antenatal follow-up ensured at 78.4%. The monitoring of the work of childbirth was ensured by the matrons in 52% of the cases and only 38% by the wise women. Maternal pathologies and gynéco-obstétricales frequently associated with the mortinaissance were: the genital haemorrhage (52.43%), the dystocia (24.86%), maternal pathologies with vascular lesions (20.54%), the maternal infection (12.96%) - Anaemia (4.90%), the foetal suffering (4.30%).

CONCLUSION

The mortinaissance is a frequent tragedy and often poses a medico-legal problem and of public health, better followed antenatal and a correct monitoring of work could reduce occurred of such a drama.

[Twin pregnancy after tubal ligation: case report]

The binding of the horns takes a place growing among the various processes of birth-control. This binding of the horns is almost irreversible and the women who make recourse to this method are generally saddles which think of having achieved their families.

Hereditary spastic paraplegia and amyotrophy associated with a novel locus on chromosome 19

We identified a family in Mali with two sisters affected by spastic paraplegia. In addition to spasticity and weakness of the lower limbs, the patients had marked atrophy of the distal upper extremities. Homozygosity mapping using single nucleotide polymorphism arrays showed that the sisters shared a region of extended homozygosity at chromosome 19p13.11-q12 that was not shared by controls. These findings indicate a clinically and genetically distinct form of hereditary spastic paraplegia with amyotrophy, designated SPG43.

[Relevance of the systematic culture of the intraoperative swab and drain tip of Redon in orthopaedic-traumatology surgery]

BACKGROUND

Post operative infections are more severe complications in bone surgery. The first stage culture on drain tip or intraoperative swab are not well known according to clear, open and aseptic orthopaedic surgery to predict wounds infections.

OBJECTIVE

To show the place of the systemic bacteriological culture of an intraoperative swab and the proximal tip of the Redon in bone surgery.

METHODS

This was a prospective continuous series of 92 interventions performed in the service of Orthopaedics Traumatology of Treichville University Hospital (Abidjan, Côte d'Ivoire). The lesions included were allocated into three groups based on the National Research Council classification. Group 1 consisted of 50 subjects with clean lesions and hyper clean. Group 2 was made up of 25 subjects with clean lesions contaminated or contamined ab initio while Group 3 consisted of 17 patients with the septic lesions. Fifty six men and 36 women with an average age of 36.9 years had two types of swabs culture. In the first type sample of intra operative haematoma or the pus before using antiseptic products was used; the second type of culture used the proximal tip of Redon at the time of its ablation. These two swabs were put in a sterile vial and sent to the same laboratory for culture.

RESULTS

The overall sepsis rate was of 24(26,1%). The microbial population was dominated by the gram negative bacilli, bacilli positive intraoperative cultures were most frequent in the group 3. 15 (88,2%). The positivity of the culture of the Redon was high in the group 2 (32%) and in the group 3 (52.9%). There was a significant difference between these two groups of surgery. The sensitivity, the specificity, and the predictive values were low. For all groups, the reports of likelihood observed didn't permit to establish a relation of cause or effect between a positive culture and the occurrence of post operative infection.

CONCLUSION

The gram negative bacilli were mostly observed on the culture of the site of infection. Although there was no significant relationshionship, it appears from the frequency that there may be a clinical link between the positive culture and open fracture.

A new oxygenated ursane derivative from Canthium multiflorum

A new ursane derivative, 3-oxo-15alpha,19alpha-dihydroxyursa-1,12-dien-28-oic acid, was isolated from the roots of Canthium multiflorum (Rubiaceae) along with 10-O-acetylgeniposidic acid, 6,7-dimethoxycoumarin, hymexelsin, scopoletin, and 5,6,7-trimethoxycoumarin.